Mackenzie E Douglas, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8647 Issued in OR

Practice address

7615 SW Capitol Hwy
Portland, OR 97219-2436

Phone

(503) 244-3712

Fax

(503) 244-2122

NPI assigned

Jul 25, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oswego Dental Associates

  dba Lake Oswego Dental Center

  • General Practice Dentistry
  • Lake Oswego, OR
  • NPI 1649293663
  NPD (past)

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1639192693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7615 SW CAPITOL HWY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972192436",
            "telephone_number": "503-244-3712",
            "fax_number": "503-244-2122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7615 SW CAPITOL HWY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972192436",
            "telephone_number": "503-244-3712",
            "fax_number": "503-244-2122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9 Monroe Pkwy Ste C",
            "address_purpose": "LOCATION",
            "city": "Lake Oswego",
            "state": "OR",
            "postal_code": "970358855",
            "country_code": "US",
            "telephone_number": "503-635-3431",
            "fax_number": "503-635-2306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MACKENZIE",
        "middle_name": "E",
        "name_prefix": "Ms.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Morrison Douglas, MD
• Edmond Arlen Douglas
• Emelie Angelina Douglas, MA, LPC
• Jae Patricia Douglas, LMSW, PH.D.
• Kaitlyn Douglas, LMT
• Peter Douglas, DDS
• Savanna Douglas
• Shannon B Douglas, RN
• Susan Douglas
• Geri Douglass

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; 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.

Verify at the official NPI Registry.