John Gabriel Colasurdo, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

5948 Issued in OR

Practice address

833 SW 11TH Ave
Suite 723
Portland, OR 97205

Phone

(503) 223-7661

Fax

(503) 223-6997

NPI assigned

Sep 1, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• John G. Colasurdo D.M.D

  • Dentist
  • Portland, OR
  • NPI 1427452085
  NPD (past) Authorized official
• Colasurdodmd LLC

  • General Practice Dentistry
  • Portland, OR
  • NPI 1275259418
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1427150341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 723",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-223-7661",
            "fax_number": "503-223-6997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 SW 11TH AVE",
            "address_2": "SUITE 723",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97205",
            "telephone_number": "503-223-7661",
            "fax_number": "503-223-6997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLASURDO",
        "first_name": "JOHN",
        "middle_name": "GABRIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "5948",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristin Colabrese, LCSW
• Claire Colaco, LMFT
• Nalini Anne Colaco, M.D., PH.D.
• Amy Rose Colagiovanni Morrison
• Christopher Colasurdo, DO, MPH
• Marco Colasurdo
• Melissa Kay Colasurdo, DMD
• Vincent Colasurdo, D.M.D.
• Colasurdodmd LLC
• Estefania Colazo

• Dentist in Portland, OR
• Providers in Portland, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.