Susan Connie Smith, DMD, PC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6200 Issued in OR

Practice address

5805 SE Milwaukie Ave
Portland, OR 97202-5255

Phone

(503) 233-5825

Fax

(503) 239-7268

NPI assigned

Aug 15, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• BD-Sellwood, LLC

  dba Brookside Dental-Gresham

  • Dental Clinic/Center
  • Portland, OR
  • NPI 1679252514
  NPD (past)
• Brookside Dental-Sellwood, LLC

  • Dental Clinic/Center
  • Portland, OR
  • NPI 1578151791
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740393925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025255",
            "telephone_number": "503-233-5825",
            "fax_number": "503-239-7268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5805 SE MILWAUKIE AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972025255",
            "telephone_number": "503-233-5825",
            "fax_number": "503-239-7268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "SUSAN",
        "middle_name": "CONNIE",
        "name_prefix": "Dr.",
        "credential": "DMD, PC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "6200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Irene Smith
• Stephanie Rucci Smith, LMT
• Stephen Mark Smith, MBBS (MD EQUIVALENT)
• Susan Smith, MSW
• Susan Smith
• Susan Irene Smith, RN, FNP
• Tavis B Smith, PHARMD
• Tessa Marie Smith, DO
• Tical Lalelia Yvette Smith
• Tiffany Veronica Smith, CST

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.