NPIMap

Organization Active NPI

Hollywood Children'S Dentistry

  • Pediatric Dentistry
  • Portland, OR
National Provider Identifier
1538438296
Registry record updated Dec 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D7649 Issued in OR
Legal business name
HOLLYWOOD CHILDREN'S DENTISTRY
Practice address
3839 NE Tillamook St
Portland, OR 97212-5338
Phone
(503) 288-5891
Fax
(503) 288-1525
NPI assigned
Dec 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2011

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

Authorized official

Name
Dr. Krista V Badger, DDS
Title
Owner/Partner
Phone
(503) 288-5891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D7649 OR Primary

Addresses

Primary practice location

3839 NE Tillamook St
Portland, OR 97212-5338

Mailing address

3839 NE Tillamook St
Portland, OR 97212-5338
Phone (503) 288-5891

National Provider Directory

National Provider Directory

Locations

3839 NE Tillamook St
Portland, OR 97212
Phone (503) 288-5891

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1324598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1324598400000",
    "number": "1538438296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3839 NE TILLAMOOK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125338",
            "telephone_number": "503-288-5891",
            "fax_number": "503-288-1525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3839 NE TILLAMOOK ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972125338",
            "telephone_number": "503-288-5891",
            "fax_number": "503-288-1525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLYWOOD CHILDREN'S DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-23",
        "last_updated": "2011-12-23",
        "status": "A",
        "authorized_official_last_name": "BADGER",
        "authorized_official_first_name": "KRISTA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER/PARTNER",
        "authorized_official_telephone_number": "503-288-5891",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D7649",
            "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 Dec 23, 2011; 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.