Active NPI
Noushin Shakiba, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1619149671
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D8995
- Practice address
- 3580 SE 82ND Ave
Portland, OR 97266-2902 - Phone
- (503) 777-0761
- Fax
- (503) 777-0393
- NPI assigned
- Mar 31, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8995 | OR | Primary |
Addresses
Primary practice location
3580 SE 82ND Ave
Portland, OR 97266-2902
Mailing address
3580 SE 82ND Ave
Portland, OR 97266-2902
Phone (503) 777-0761
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170421000163 | CA | Order and Referring Only - Dentist | 2769768019 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8995 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206921600000",
"number": "1619149671",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3580 SE 82ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972662902",
"telephone_number": "503-777-0761",
"fax_number": "503-777-0393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3580 SE 82ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972662902",
"telephone_number": "503-777-0761",
"fax_number": "503-777-0393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAKIBA",
"first_name": "NOUSHIN",
"name_prefix": "Ms.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-31",
"last_updated": "2008-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D8995",
"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 Mar 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.