Active NPI
Kevin James Ford, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1467704858
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D9791
- Practice address
- 10535 NE Glisan St
Suite 301
Portland, OR 97220-4077 - Phone
- (503) 444-2824
- NPI assigned
- Oct 9, 2012
- Last updated
- Jan 22, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D9791 | OR | Primary |
Addresses
Primary practice location
10535 NE Glisan St
Suite 301
Portland, OR 97220-4077
Mailing address
14201 NE 20TH Ave Ste 2204
Vancouver, WA 98686-6413
Phone (360) 975-7641
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9791 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421884800000",
"number": "1467704858",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14201 NE 20TH AVE STE 2204",
"city": "VANCOUVER",
"state": "WA",
"postal_code": "986866413",
"telephone_number": "360-975-7641"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10535 NE GLISAN ST",
"address_2": "SUITE 301",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972204077",
"telephone_number": "503-444-2824"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORD",
"first_name": "KEVIN",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-10-09",
"last_updated": "2015-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D9791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.