Bryan Clevenger, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D11035 Issued in OR

Practice address

7095 SW Gonzaga St
Tigard, OR 97223-8309

Phone

(855) 433-6825

NPI assigned

Jun 11, 2015

Sex

Male

Sole proprietor

Yes

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 6, 2023 through Jan 6, 2027

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Associates for Oral & Maxillofacial Surgery

  • Oral and Maxillofacial Surgery (Dentist)
  • Medford, OR
  • NPI 1184625980
  NPD (past)

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601424000000",
    "number": "1780065128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6950 NE CAMPUS WAY",
            "city": "HILLSBORO",
            "state": "OR",
            "postal_code": "971245611",
            "telephone_number": "855-433-6825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7095 SW GONZAGA ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972238309",
            "telephone_number": "855-433-6825"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7703 Floyd Curl Dr",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782293901",
            "country_code": "US",
            "telephone_number": "210-567-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1625 E McAndrews Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "97504",
            "country_code": "US",
            "telephone_number": "541-779-3781",
            "fax_number": "541-779-6523",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1625 E McAndrews Rd Ste A",
            "address_purpose": "LOCATION",
            "city": "Medford",
            "state": "OR",
            "postal_code": "97504",
            "country_code": "US",
            "telephone_number": "541-779-3781",
            "fax_number": "541-779-6523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLEVENGER",
        "first_name": "BRYAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-11",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D11035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Clarke, LMT
• Peggy Sue Clay
• Rebecca M Cleeton, DO
• Rebekah Dawn Clement
• Eileen Melody Cleveland, ARNP
• Denise Clopton, LMT
• Coacheslibrary
• Jon Coachman
• Crystal Lee Coburn
• Chris Cochran

• Oral and Maxillofacial Surgery (Dentist) in Tigard, OR
• Providers in Tigard, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.