NPIMap

Organization Active NPI

Cedar Hills Legacy Dental LLC

  • Dental Clinic/Center
  • Portland, OR
National Provider Identifier
1659632677
Registry record updated Jun 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
D9096 Issued in OR
Legal business name
CEDAR HILLS LEGACY DENTAL LLC
Practice address
2375 SW Cedar Hills Blvd
Portland, OR 97225-4513
Phone
(503) 644-2910
Fax
(503) 646-5565
NPI assigned
Jun 6, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2012

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

Authorized official

Name
Sheryl L Ecklund
Title
Office Manager
Phone
(503) 644-2910

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X D9096 OR Primary

Addresses

Primary practice location

2375 SW Cedar Hills Blvd
Portland, OR 97225-4513

Mailing address

2375 SW Cedar Hills Blvd
Portland, OR 97225-4513
Phone (503) 644-2910

National Provider Directory

National Provider Directory

Locations

2375 SW Cedar Hills Blvd
Portland, OR 97225
Phone (503) 644-2910

Practitioners & affiliated clinicians

Practitioners 1

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": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338940800000",
    "number": "1659632677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 SW CEDAR HILLS BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254513",
            "telephone_number": "503-644-2910",
            "fax_number": "503-646-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 SW CEDAR HILLS BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972254513",
            "telephone_number": "503-644-2910",
            "fax_number": "503-646-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CEDAR HILLS LEGACY DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2012-06-06",
        "status": "A",
        "authorized_official_last_name": "ECKLUND",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-644-2910"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D9096",
            "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 Jun 6, 2012; 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.