NPIMap

Organization Active NPI

Zack Porter D.D.S. PC

Doing business as Skyline Dental

  • Dentist
  • Bend, OR
National Provider Identifier
1760863096
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D9091 Issued in OR
Legal business name
ZACK PORTER D.D.S. PC
Doing business as
Skyline Dental
Practice address
2137 NE 4TH St
Bend, OR 97701-3824
Phone
(541) 389-4807
NPI assigned
Jun 11, 2015
Last updated
Jun 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

Name
Dr. Zack Joseph Porter, D.D.SNPI 1871730440
Title
Owner
Phone
(541) 647-4611

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D9091 OR Primary

Addresses

Primary practice location

2137 NE 4TH St
Bend, OR 97701-3824

Mailing address

1855 NW Iowa Ave
Bend, OR 97701-1009
Phone (541) 647-4611

Other names 1

  • Skyline Dental Doing business as

National Provider Directory

National Provider Directory

Locations

2137 NE 4th St
Bend, OR 97701
Phone (541) 389-4807

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1760863096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 NW IOWA AVE",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977011009",
            "telephone_number": "541-647-4611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2137 NE 4TH ST",
            "city": "BEND",
            "state": "OR",
            "postal_code": "977013824",
            "telephone_number": "541-389-4807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZACK PORTER D.D.S. PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "ZACK",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-647-4611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Skyline Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2015; 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.