NPIMap

Organization Active NPI

Willamette

  • Dentist
  • Gresham, OR
National Provider Identifier
1649692450
Registry record updated Jan 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7585 Issued in OR
Legal business name
WILLAMETTE
Practice address
1107 NE Burnside Rd
Gresham, OR 97030-5710
Phone
(503) 952-2167
NPI assigned
Jan 13, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2014

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

Authorized official

Name
Dr. Sheida Kharrazi, DMDNPI 1740288174
Title
Dentist
Phone
(503) 310-0923

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
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X 7585 OR Primary

Addresses

Primary practice location

1107 NE Burnside Rd
Gresham, OR 97030-5710

Mailing address

6950 NE Campus Way
Hillsboro, OR 97124-5611
Phone (503) 952-2167

National Provider Directory

National Provider Directory

Locations

1107 NE Burnside Rd
Gresham, OR 97030
Phone (503) 663-1404

Practitioners & affiliated clinicians

Practitioners 8

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": "1389571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389571200000",
    "number": "1649692450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611",
            "telephone_number": "503-952-2167",
            "fax_number": "503-952-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1107 NE BURNSIDE RD",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305710",
            "telephone_number": "503-952-2167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-13",
        "last_updated": "2014-01-13",
        "status": "A",
        "authorized_official_last_name": "KHARRAZI",
        "authorized_official_first_name": "SHEIDA",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "503-310-0923",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "OR",
            "license": "7585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2014; 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.