Pettygrove Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9708 Issued in OR

Legal business name

PETTYGROVE DENTAL LLC

Practice address

2267 NW Pettygrove St
Portland, OR 97210-2760

Phone

(503) 224-6317

NPI assigned

Feb 23, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Carmel Dudley Doran, D.D.S.NPI 1902067077

Title

Dentist

Phone

(503) 224-6317

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carmel Dudley Doran, DDS

  • General Practice Dentistry
  • Portland, OR
  • NPI 1902067077
  NPD (past) Authorized official
• Craig C. Benben, D.M.D.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1801815931
  NPD (past)
• Andrew Lawrence Riddle, DMD

  • Dentist
  • Portland, OR
  • NPI 1386472207
  NPD (past)

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487808000000",
    "number": "1558801597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2267 NW PETTYGROVE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102760",
            "telephone_number": "503-224-6317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2267 NW PETTYGROVE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102760",
            "telephone_number": "503-224-6317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETTYGROVE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-23",
        "last_updated": "2017-02-23",
        "status": "A",
        "authorized_official_last_name": "DORAN",
        "authorized_official_first_name": "CARMEL",
        "authorized_official_middle_name": "DUDLEY",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-224-6317",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas A Pettit, DO
• Jennifer Nicole Petty
• Michelle Elizabeth Petty
• Randi Michelle Petty, RDH
• Terry Lee Petty, DC
• Pettygrove Physical Therpay Associates LLC
• Ethan David Pettyjohn, LPC
• Karen E Petzing, D.C.
• Lara Michelle Pevzner, M.A., LPC
• Brittany Pew, MS, OTR/L

• 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 Feb 23, 2017; 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.