Roger Krupetsky

Primary specialty

DentistTaxonomy code 122300000X

License

D12158 Issued in OR

Practice address

3280 NE Broadway St
Portland, OR 97232-1815

Phone

(503) 282-0521

NPI assigned

Dec 22, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Grant Park Dentistry, PC

  • General Practice Dentistry
  • Portland, OR
  • NPI 1205220209
  NPD (past)

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

{
    "created_epoch": "1703203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782691200000",
    "number": "1477322014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3280 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321815",
            "telephone_number": "503-282-0521"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "707 Parnassus Ave",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941432210",
            "country_code": "US",
            "telephone_number": "415-502-5800",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRUPETSKY",
        "first_name": "ROGER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-22",
        "last_updated": "2026-06-29",
        "certification_date": "2026-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D12158",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Krulewitch, LCSW
• Veronica Elise Krull, MD
• Patrick Martin Krum, CRNA
• Robert Krum, M.D.
• Emily Christine Krump, R.N.
• Dawn Krusch
• Dohn Royal Kruschwitz, MD, ND
• Karen Kruse
• Katherine Idell Thompson Kruse
• Rebekka Kruse

• 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 Jun 29, 2026; 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.