NPIMap

Organization Active NPI

Brookside Dental - Milwaukie, LLC

Doing business as Brookside Dental - Clackamas

  • General Practice Dentistry
  • Clackamas, OR
National Provider Identifier
1649635384
Registry record updated Mar 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BROOKSIDE DENTAL - MILWAUKIE, LLC
Doing business as
Brookside Dental - Clackamas
Practice address
9225 SE Sunnyside Rd. Ste 1
Clackamas, OR 97015
Phone
(503) 905-3380
Fax
(503) 200-1444
NPI assigned
Dec 23, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2018

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

Authorized official

Name
Robert J Kowal, DDS
Title
Owner/Dentist
Phone
(503) 905-3380

Specialties & licenses 1

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

Addresses

Primary practice location

9225 SE Sunnyside Rd. Ste 1
Clackamas, OR 97015

Mailing address

9225 SE Sunnyside Rd. Ste 1
Clackamas, OR 97015
Phone (503) 905-3380

Other names 1

  • Brookside Dental - Clackamas Doing business as

National Provider Directory

National Provider Directory

Locations

9225 SE Sunnyside Rd
Ste 1
Clackamas, OR 97015
Phone (503) 905-3380

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1450828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521417600000",
    "number": "1649635384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9225 SE SUNNYSIDE RD. STE 1",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "97015",
            "telephone_number": "503-905-3380",
            "fax_number": "503-200-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9225 SE SUNNYSIDE RD. STE 1",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "97015",
            "telephone_number": "503-905-3380",
            "fax_number": "503-200-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE DENTAL - MILWAUKIE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-23",
        "last_updated": "2018-03-19",
        "status": "A",
        "authorized_official_last_name": "KOWAL",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "503-905-3380",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Dental - Clackamas",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brookside Dental - Clackamas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clackamas, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.