Individual provider Active NPI

Benjamin Hanby Steward

  • Dental Therapist
  • Portland, OR
National Provider Identifier
1548537020
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental TherapistTaxonomy code 125J00000X
License
11-068-DHAT Issued in AK
Practice address
12750 SE Stark St BLDG E
Portland, OR 97233-1539
Phone
(971) 347-3009
Fax
(971) 256-3277
NPI assigned
Nov 28, 2011
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Therapist 125J00000X 11-068-DHAT AK Primary

Addresses

Primary practice location

12750 SE Stark St BLDG E
Portland, OR 97233-1539

Mailing address

1776 SW Madison St
Portland, OR 97205-1715
Phone (971) 386-2278

Other practice location 1

123 Tok cutoff
Tok, AK 99780-0083
Phone (907) 883-5185 ext. 5229

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

LicenseStateTypeSpecialty
11-068-DHATAKMDDental Therapist

NPI Registry JSON

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

{
    "created_epoch": "1322438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1548537020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1776 SW MADISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051715",
            "telephone_number": "971-386-2278",
            "fax_number": "503-224-4494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12750 SE STARK ST BLDG E",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972331539",
            "telephone_number": "971-347-3009",
            "fax_number": "971-256-3277"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "123 Tok cutoff",
            "address_purpose": "LOCATION",
            "city": "Tok",
            "state": "AK",
            "postal_code": "997800083",
            "country_code": "US",
            "telephone_number": "907-883-5185 x5229",
            "fax_number": "907-459-3925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STEWARD",
        "first_name": "BENJAMIN",
        "middle_name": "HANBY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-11-28",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "125J00000X",
            "taxonomy_group": "",
            "desc": "Dental Therapist",
            "state": "AK",
            "license": "11-068-DHAT",
            "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 Jul 21, 2022; 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.