Active NPI
Steven Raymond Dierickx, DMD
- General Practice Dentistry
- Forest Grove, OR
National Provider Identifier
1629032255
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 4924
- Practice address
- 2031 Hawthorne St
Suite G
Forest Grove, OR 97116-1700 - Phone
- (503) 357-2171
- Fax
- (503) 357-2172
- NPI assigned
- Apr 12, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 4924 | OR | Primary |
Addresses
Primary practice location
2031 Hawthorne St
Suite G
Forest Grove, OR 97116-1700
Mailing address
2031 Hawthorne St
Suite G
Forest Grove, OR 97116-1700
Phone (503) 357-2171
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4924 | Other | OR | LICENSE NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4924 | OR | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144800000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1629032255",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2031 HAWTHORNE ST",
"address_2": "SUITE G",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971161700",
"telephone_number": "503-357-2171",
"fax_number": "503-357-2172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2031 HAWTHORNE ST",
"address_2": "SUITE G",
"city": "FOREST GROVE",
"state": "OR",
"postal_code": "971161700",
"telephone_number": "503-357-2171",
"fax_number": "503-357-2172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIERICKX",
"first_name": "STEVEN",
"middle_name": "RAYMOND",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-12",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "4924",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE NUMBER",
"identifier": "4924",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Grove, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.