NPIMap

Organization Active NPI

Willamette Dental

  • Preferred Provider Organization
  • Portland, OR
National Provider Identifier
1770905879
Registry record updated Jan 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
H5086 Issued in OR
Legal business name
WILLAMETTE DENTAL
Practice address
17804 NW Marylhurst Dr
Portland, OR 97229-7913
Phone
(503) 533-1755
NPI assigned
Jan 9, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2014

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

Authorized official

Name
Elina BudrevichNPI 1811375421
Title
Dental Hygienist
Phone
(503) 533-1755

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
Preferred Provider Organization 305R00000X H5086 OR Primary

Addresses

Primary practice location

17804 NW Marylhurst Dr
Portland, OR 97229-7913

Mailing address

4925 SW Griffith Dr
Beaverton, OR 97005-2923

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389225600000",
    "number": "1770905879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4925 SW GRIFFITH DR",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970052923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17804 NW MARYLHURST DR",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972297913",
            "telephone_number": "503-533-1755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLAMETTE DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-09",
        "last_updated": "2014-01-09",
        "status": "A",
        "authorized_official_last_name": "BUDREVICH",
        "authorized_official_first_name": "ELINA",
        "authorized_official_title_or_position": "DENTAL HYGIENIST",
        "authorized_official_telephone_number": "503-533-1755"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "OR",
            "license": "H5086",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 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.