Active NPI
Michelle C. Keys, DMD
- Dentist
- Portland, OR
National Provider Identifier
1508947102
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D7076
- Practice address
- 12710 SE Division St
Portland, OR 97236-3134 - Phone
- (503) 988-3410
- Fax
- (503) 988-5903
- NPI assigned
- Oct 18, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Dentist | 122300000X | D7076 | OR | Primary |
Addresses
Primary practice location
12710 SE Division St
Portland, OR 97236-3134
Mailing address
12710 SE Division St
Portland, OR 97236-3134
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 182468 | Medicaid | OR |
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 |
|---|---|---|---|
| D7076 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508947102",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12710 SE DIVISION ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972363134"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12710 SE DIVISION ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972363134",
"telephone_number": "503-988-3410",
"fax_number": "503-988-5903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEYS",
"first_name": "MICHELLE",
"middle_name": "C.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D7076",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "182468",
"state": "OR"
}
],
"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 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.