Organization Active NPI

West Tabor Dental LLC

  • General Practice Dentistry
  • Portland, OR
National Provider Identifier
1629936679
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WEST TABOR DENTAL LLC
Practice address
5043 SE Hawthorne Blvd
Portland, OR 97215-3255
Phone
(503) 232-8847
Fax
(503) 232-6890
NPI assigned
Jan 9, 2026
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Authorized official

Name
Tracy Avritt
Title
Office Manager
Phone
(503) 232-8847

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

5043 SE Hawthorne Blvd
Portland, OR 97215-3255

Mailing address

5043 SE Hawthorne Blvd
Portland, OR 97215-3255
Phone (503) 232-8847

National Provider Directory

National Provider Directory

Locations

5043 SE Hawthorne Blvd
Portland, OR 97215
Phone (503) 232-8847

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1767916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768176000000",
    "number": "1629936679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5043 SE HAWTHORNE BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972153255",
            "telephone_number": "503-232-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5043 SE HAWTHORNE BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972153255",
            "telephone_number": "503-232-8847",
            "fax_number": "503-232-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST TABOR DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-09",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A",
        "authorized_official_last_name": "AVRITT",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-232-8847"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "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 Jan 12, 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.

Verify at the official NPI Registry.