NPIMap

Organization Active NPI

Sandy Dental Clinic PC

  • General Practice Dentistry
  • Beaverton, OR
National Provider Identifier
1699818088
Registry record updated Jun 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D6709 Issued in OR
Legal business name
SANDY DENTAL CLINIC PC
Practice address
12520 SW 1St St
Beaverton, OR 97005-0550
Phone
(503) 646-5230
Fax
(503) 626-1813
NPI assigned
Feb 15, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2015

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

Authorized official

Name
Dr. Khiet Minh Tran, D.D.S.
Title
President
Phone
(503) 646-5230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D6709 OR Primary

Addresses

Primary practice location

12520 SW 1St St
Beaverton, OR 97005-0550

Mailing address

12520 SW 1St St
Beaverton, OR 97005-0550
Phone (503) 646-5230

National Provider Directory

National Provider Directory

Locations

12520 SW 1st St
Beaverton, OR 97005
Phone (503) 348-5804

Practitioners & affiliated clinicians

Practitioners 5

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": "1171497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1699818088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12520 SW 1ST ST",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970050550",
            "telephone_number": "503-646-5230",
            "fax_number": "503-626-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12520 SW 1ST ST",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970050550",
            "telephone_number": "503-646-5230",
            "fax_number": "503-626-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANDY DENTAL CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-15",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "KHIET",
        "authorized_official_middle_name": "MINH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "503-646-5230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2015; 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.