Active NPI
Michelle D Stafford, D.D.S.
- Pediatric Dentistry
- Portland, OR
National Provider Identifier
1801053947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- D9074
- Practice address
- 11790 SW Barnes Rd BLDG a
Suite 280
Portland, OR 97225-5934 - Phone
- (503) 555-5555
- NPI assigned
- May 16, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D9074 | OR | Primary |
Addresses
Primary practice location
11790 SW Barnes Rd BLDG a
Suite 280
Portland, OR 97225-5934
Mailing address
11790 SW Barnes Rd BLDG a
Suite 280
Portland, OR 97225-5934
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D9074 | OR | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210896000000",
"number": "1801053947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11790 SW BARNES RD BLDG A",
"address_2": "SUITE 280",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255934"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11790 SW BARNES RD BLDG A",
"address_2": "SUITE 280",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972255934",
"telephone_number": "503-555-5555"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STAFFORD",
"first_name": "MICHELLE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-16",
"last_updated": "2008-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OR",
"license": "D9074",
"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 May 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.