Samuel Gottlieb, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D7245 Issued in OR

Practice address

17675 SW Tualatin Valley Hwy
Beaverton, OR 97006-4443

Phone

(503) 259-3160

NPI assigned

Jul 19, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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)

Enrolled

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750300687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12401 SHELBY CT",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970351102",
            "telephone_number": "503-245-0384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17675 SW TUALATIN VALLEY HWY",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064443",
            "telephone_number": "503-259-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTLIEB",
        "first_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D7245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• David Graf, RPH
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• Erin Elizabeth Grant

• Periodontics in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Periodontics 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.