NPIMap

Organization Active NPI

Roots Dental Broadway LLC

  • Dental Clinic/Center
  • Portland, OR
National Provider Identifier
1568977817
Registry record updated Dec 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D10629 Issued in OR
Legal business name
ROOTS DENTAL BROADWAY LLC
Practice address
2525 NE Broadway St Ste 200
Portland, OR 97232-3527
Phone
(503) 234-7870
NPI assigned
Dec 8, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2017

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

Authorized official

Name
Ryan Smith, DDS
Title
Manager
Phone
(503) 234-7870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D10629 OR Primary

Addresses

Primary practice location

2525 NE Broadway St Ste 200
Portland, OR 97232-3527

Mailing address

2525 NE Broadway St Ste 200
Portland, OR 97232-3527

Other names 1

  • NE Dental Associates Former legal business name

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1512691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512691200000",
    "number": "1568977817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 NE BROADWAY ST STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 NE BROADWAY ST STE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323527",
            "telephone_number": "503-234-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOTS DENTAL BROADWAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-08",
        "last_updated": "2017-12-08",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "503-234-7870",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D10629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NE Dental Associates",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 8, 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.