NE 82ND Avenue Dental LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

D8506 Issued in OR

Legal business name

NE 82ND AVENUE DENTAL LLC

Practice address

2150 NE 82ND Ave
Portland, OR 97220-5607

Phone

(503) 254-0897

Fax

(503) 254-0894

NPI assigned

Aug 24, 2010

Last updated

Aug 24, 2010By 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

Sarah Nichol

Title

Office Manager

Phone

(503) 254-0897

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1282608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282608000000",
    "number": "1700192184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2150 NE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205607",
            "telephone_number": "503-254-0897",
            "fax_number": "503-254-0894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 NE 82ND AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972205607",
            "telephone_number": "503-254-0897",
            "fax_number": "503-254-0894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NE 82ND AVENUE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-24",
        "last_updated": "2010-08-24",
        "status": "A",
        "authorized_official_last_name": "NICHOL",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-254-0897"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D9389",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D8961",
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "OR",
            "license": "D8506",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Nazzaro, M.S.W.
• NCFC (Canyon Medical Center)
• NCNM Clinic
• Fanna Ndow
• David N Nduru
• NE Dental Associates
• Neal Allan Dunitz, MD
• Cassidy Anne Neal
• Edward Neal, MD
• Jaden Makena Neal

• 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 Aug 24, 2010; 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.