Organization Active NPI

Brookside Dental-Gresham

  • Public Health Dentistry
  • Gresham, OR
National Provider Identifier
1700201464
Registry record updated Mar 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health DentistryTaxonomy code 1223D0001X
License
D7444 Issued in OR
Legal business name
BROOKSIDE DENTAL-GRESHAM
Practice address
4255 SE 182ND Ave
Gresham, OR 97030-5083
Phone
(503) 666-2515
Fax
(503) 618-9254
NPI assigned
Mar 4, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2014

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

Authorized official

Name
Dr. Brian Reed Westover, D,M,D
Title
Owner/Dentist
Phone
(503) 723-8722

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223D0001X D7444 OR Primary

Addresses

Primary practice location

4255 SE 182ND Ave
Gresham, OR 97030-5083

Mailing address

4255 SE 182ND Ave
Gresham, OR 97030-5083
Phone (503) 666-2515

National Provider Directory

National Provider Directory

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": "1393891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1393891200000",
    "number": "1700201464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 SE 182ND AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305083",
            "telephone_number": "503-666-2515",
            "fax_number": "503-618-9254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 SE 182ND AVE",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970305083",
            "telephone_number": "503-666-2515",
            "fax_number": "503-618-9254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE DENTAL-GRESHAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-04",
        "last_updated": "2014-03-04",
        "status": "A",
        "authorized_official_last_name": "WESTOVER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "REED",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "503-723-8722",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D,M,D"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Public Health",
            "state": "OR",
            "license": "D7444",
            "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 Mar 4, 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.