Timber Dental Bethany

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TIMBER DENTAL BETHANY

Practice address

15715 NW Central Dr Ste 7-8
Portland, OR 97229-1267

Phone

(503) 336-3373

NPI assigned

Feb 14, 2019

Last updated

Jun 11, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ryan Berg

Title

Billing Coordinator

Phone

(503) 419-6288

Specialties & licenses 1

Addresses

Other identifiers 8

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1548726581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15715 NW CENTRAL DR STE 7-8",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972291267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15715 NW CENTRAL DR STE 7-8",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972291267",
            "telephone_number": "503-336-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBER DENTAL BETHANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-14",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "503-419-6288"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639504715",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1780605287",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952684169",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1821225442",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851845036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144213802",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1033404751",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1295143212",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamelah Doris Tilus, M.S.
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• Tim Foulke Ms, Pmhnp PC
• Timber Dental
• Timber Dental - Lombard (Timber Dental)
• Timber Dental Downtown LLC
• Timber Dental East Burnside
• Timber Dental LLC (Timber Dental)
• Gabriel Time, PA
• Brian Andrew Timm, PAC

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.