82ND Drive Dental Clinic

Primary specialty

DentistTaxonomy code 122300000X

License

D8618 Issued in OR

Legal business name

82ND DRIVE DENTAL CLINIC

Practice address

15480 SE 82ND Dr
Clackamas, OR 97015-9633

Phone

(503) 655-7250

Fax

(503) 650-6375

NPI assigned

Oct 8, 2014

Last updated

Oct 8, 2014By 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

Bradley W Carpenter, DMDNPI 1912271164

Title

Owner/ Dentist

Phone

(503) 655-7250

Specialties & licenses 1

Addresses

Practitioners 2

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.

• Bradley Wayne Carpenter, DMD

  • General Practice Dentistry
  • Clacamas, OR
  • NPI 1912271164
  NPD (past) Authorized official
• Ryan Carpenter, DMD

  • Dentist
  • Clackamas, OR
  • NPI 1912301672
  NPD (past)

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1740683465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 446",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970150446",
            "telephone_number": "503-655-7250",
            "fax_number": "503-650-6375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15480 SE 82ND DR",
            "city": "CLACKAMAS",
            "state": "OR",
            "postal_code": "970159633",
            "telephone_number": "503-655-7250",
            "fax_number": "503-650-6375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "82ND DRIVE DENTAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "CARPENTER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER/ DENTIST",
        "authorized_official_telephone_number": "503-655-7250",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D8618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Isaac Thomas Abernethy
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• Dentist in Clackamas, OR
• Providers in Clackamas, OR by specialty
• Dentist in Oregon

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