NPIMap

Organization Active NPI

World of Smiles, Pediatric Dentistry LLC

  • Pediatric Dentistry
  • Portland, OR
National Provider Identifier
1801183488
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
D9074 Issued in OR
Legal business name
WORLD OF SMILES, PEDIATRIC DENTISTRY LLC
Practice address
11790 SW Barnes Rd Ste 280
Portland, OR 97225-5935
Phone
(503) 626-9700
Fax
(503) 626-9772
NPI assigned
Jul 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Authorized official

Name
Dr. Michelle Stafford, DDS
Title
Dentist/Owner
Phone
(503) 626-9700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X D9074 OR Primary

Addresses

Primary practice location

11790 SW Barnes Rd Ste 280
Portland, OR 97225-5935

Mailing address

11790 SW Barnes Rd Ste 280
Portland, OR 97225-5935
Phone (503) 626-9700

Other identifiers 2

IdentifierTypeStateIssuer
1604500OtherORUNITED CONCORDIA
218744MedicaidOR

National Provider Directory

National Provider Directory

Locations

11790 SW Barnes Rd
Ste 280
Portland, OR 97225
Phone (503) 555-5555

Practitioners & affiliated clinicians

Practitioners 6

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": "1309824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309996800000",
    "number": "1801183488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 280",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255935",
            "telephone_number": "503-626-9700",
            "fax_number": "503-626-9772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11790 SW BARNES RD STE 280",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255935",
            "telephone_number": "503-626-9700",
            "fax_number": "503-626-9772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WORLD OF SMILES, PEDIATRIC DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-05",
        "last_updated": "2011-07-07",
        "status": "A",
        "authorized_official_last_name": "STAFFORD",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "503-626-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D9074",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1604500",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "218744",
            "state": "OR"
        }
    ],
    "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 Jul 7, 2011; 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.