NPIMap

Organization Active NPI

Tigard Modern Dentistry and Orthodontics, PC

  • General Practice Dentistry
  • Tigard, OR
National Provider Identifier
1649640434
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
TIGARD MODERN DENTISTRY AND ORTHODONTICS, PC
Practice address
12266 SW Scholls Ferry Rd
Tigard, OR 97223-3354
Phone
(503) 455-8483
Fax
(503) 521-0273
NPI assigned
Oct 6, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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

Authorized official

Name
Dr. Vivian Lam, DMDNPI 1891744553
Title
Owner
Phone
(503) 455-8483

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

12266 SW Scholls Ferry Rd
Tigard, OR 97223-3354

Mailing address

PO Box 920050
Dallas, TX 75392-0050
Phone (714) 845-8890

Other names 1

  • Tigard Modern Dentistry Doing business as

National Provider Directory

National Provider Directory

Locations

12266 SW Scholls Ferry Rd
Tigard, OR 97223
Phone (503) 455-8483

Practitioners & affiliated clinicians

Practitioners 6

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": "1444089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646784000000",
    "number": "1649640434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920050",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920050",
            "telephone_number": "714-845-8890",
            "fax_number": "949-474-1495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12266 SW SCHOLLS FERRY RD",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972233354",
            "telephone_number": "503-455-8483",
            "fax_number": "503-521-0273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIGARD MODERN DENTISTRY AND ORTHODONTICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-06",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "VIVIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-455-8483",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tigard Modern Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tigard, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.