Bridgeport Family Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

D7482 Issued in OR

Legal business name

BRIDGEPORT FAMILY DENTAL, LLC

Practice address

7420 SW Bridgeport Rd Ste 104
Tigard, OR 97224-7790

Phone

(503) 430-7909

Fax

(503) 268-1501

NPI assigned

Feb 15, 2012

Last updated

Feb 15, 2012By 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

Dr. Kelly Jean Johnson, D.D.S.NPI 1437486800

Title

Owner/Dentist

Phone

(503) 430-7909

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelly J Johnson, D.D.S.

  • General Practice Dentistry
  • Tigard, OR
  • NPI 1437486800
  NPD (past) Authorized official

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1740553106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 104",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-430-7909",
            "fax_number": "503-268-1501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7420 SW BRIDGEPORT RD STE 104",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972247790",
            "telephone_number": "503-430-7909",
            "fax_number": "503-268-1501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEPORT FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "503-430-7909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D7482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Ranae Brems, MFT INTERN
• Sarah Brenner
• Marcus Brent
• Meredith Rae Brezinski, PT, DPT
• Bridgeport Dental LLC
• Bridgeport Family Medicine LLC
• Bridgeport Medical Imaging, LLC (Center for Medical Imaging-Bridgeport)
• Bridgeport MRI LLC (Clearview MRI Bridgeport)
• Bridges
• Wendy Ann Bridges, BSW, QMHA

• Dentist in Tigard, OR
• Providers in Tigard, OR by specialty
• Dentist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.