BD-Sellwood, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BD-SELLWOOD, LLC

Doing business as

Brookside Dental-Gresham
Whole Health Dentistry

Practice address

5805 SE Milwaukie Ave
Portland, OR 97202-5255

Phone

(503) 233-5825

NPI assigned

Jul 17, 2023

Last updated

Jul 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Debbie Lopez

Title

Regional Manager

Phone

(503) 914-8221

Specialties & licenses 1

Addresses

Other names 2

• Brookside Dental-Gresham Doing business as
• Whole Health Dentistry Doing business as

Locations

Practitioners 2

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.

• Kenneth Jang, D.D.S.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1508137340
  NPD
• Susan Connie Smith, DMD, PC

  • General Practice Dentistry
  • Portland, OR
  • NPI 1740393925
  NPD (past)

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

{
    "created_epoch": "1689552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1679252514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025255",
            "telephone_number": "503-233-5825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025255",
            "telephone_number": "503-233-5825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BD-SELLWOOD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-17",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "503-914-8221"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brookside Dental-Gresham",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Whole Health Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alissa Dyan Bazinet, PHD
• Claire Elizabeth Bazley
• Lyubov Bazyuk
• Marina Vladimirovna Bazyuk, ND
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• Dental Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; 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.