Individual provider Active NPI

Angela Michelle Smorra, DMD

  • Dentist
  • Cornelius, OR
National Provider Identifier
1720167596
Registry record updated Jul 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D8738 Issued in OR
Practice address
44 N 11TH Ave
Cornelius, OR 97113-9020
Phone
(503) 359-8505
Fax
(503) 359-8535
NPI assigned
Nov 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D8738 OR Primary

Addresses

Primary practice location

44 N 11TH Ave
Cornelius, OR 97113-9020

Mailing address

PO Box 568
Cornelius, OR 97113-0568
Phone (503) 352-8657

Other names 1

  • Angela Michelle Schmadeke Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160201000718 OR Order and Referring Only - DentistPractitioner - Dentist 8224332937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D8738ORMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1162512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468454400000",
    "number": "1720167596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 568",
            "city": "CORNELIUS",
            "state": "OR",
            "postal_code": "971130568",
            "telephone_number": "503-352-8657",
            "fax_number": "503-352-8658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 N 11TH AVE",
            "city": "CORNELIUS",
            "state": "OR",
            "postal_code": "971139020",
            "telephone_number": "503-359-8505",
            "fax_number": "503-359-8535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMORRA",
        "first_name": "ANGELA",
        "middle_name": "MICHELLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-03",
        "last_updated": "2016-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANGELA",
            "last_name": "SCHMADEKE",
            "middle_name": "MICHELLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cornelius, OR

Sources for this page

Verify at the official NPI Registry.