Individual provider Active NPI

Claressa T Burel, DA

  • Dental Assistant
  • Portland, OR
National Provider Identifier
1558912121
Registry record updated Sep 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AssistantTaxonomy code 126800000X
License
000567 Issued in OR
Practice address
12750 SE Stark St BLDG E
Portland, OR 97233-1539
Phone
(971) 347-3009
Fax
(971) 256-3277
NPI assigned
Sep 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Assistant 126800000X 000567 OR Primary
Dental Assistant 126800000X D160263613 WA

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 (503) 224-1044

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
000567ORMDDental Assistant
D160263613WAMDDental Assistant

NPI Registry JSON

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

{
    "created_epoch": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632182400000",
    "number": "1558912121",
    "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": "503-224-1044",
            "fax_number": "503-621-2235"
        },
        {
            "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": [],
    "basic": {
        "last_name": "BUREL",
        "first_name": "CLARESSA",
        "middle_name": "T",
        "credential": "DA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2021-09-21",
        "certification_date": "2021-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "OR",
            "license": "000567",
            "primary": true
        },
        {
            "code": "126800000X",
            "taxonomy_group": "",
            "desc": "Dental Assistant",
            "state": "WA",
            "license": "D160263613",
            "primary": false
        }
    ],
    "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 Sep 21, 2021; 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.