Willettedental

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

H5544 Issued in OR

Legal business name

WILLETTEDENTAL

Practice address

4925 SW Griffith Dr
Beaverton, OR 97005-2923

Phone

(916) 899-9665

NPI assigned

Nov 17, 2013

Organization subpart

No

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

Authorized official

Name

Peggy Clifton

Title

Dental Hygienist

Phone

(916) 899-9665

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384646400000",
    "number": "1710317482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2000",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970752000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4925 SW GRIFFITH DR",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052923",
            "telephone_number": "916-899-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLETTEDENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-17",
        "last_updated": "2013-11-17",
        "status": "A",
        "authorized_official_last_name": "CLIFTON",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_title_or_position": "DENTAL HYGIENIST",
        "authorized_official_telephone_number": "916-899-9665"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "H5544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willamette Dental
• Willamette Dental
• Willamette Dental Group
• Elaine Karen Willbanks, RN
• Jonathan Willden, MA, LPC INTERN
• Alice Maureen Williams, LPC, LMFT
• Andrew A Williams, DO
• Danica Williams
• Jay K Williams, LMT
• John R. Williams, DMD

• Preferred Provider Organization in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Preferred Provider Organization in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2013; 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.