Individual provider Active NPI

Eric C Burgin, DDS

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Beaverton, OR
National Provider Identifier
1821235839
Registry record updated Jan 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
D9145 Issued in OR
Practice address
16155 NW Cornell Rd
Ste 450
Beaverton, OR 97006-4810
Phone
(503) 629-5300
Fax
(503) 690-9452
NPI assigned
Jan 13, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X D9145 OR Primary

Addresses

Primary practice location

16155 NW Cornell Rd
Ste 450
Beaverton, OR 97006-4810

Mailing address

16155 NW Cornell Rd
Ste 450
Beaverton, OR 97006-4810
Phone (503) 629-5300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151125000243 OR Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 3375843246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D9145ORMDOrthodontics and Dentofacial Orthopedic Dentist

NPI Registry JSON

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

{
    "created_epoch": "1231804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231804800000",
    "number": "1821235839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16155 NW CORNELL RD",
            "address_2": "STE 450",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064810",
            "telephone_number": "503-629-5300",
            "fax_number": "503-690-9452"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16155 NW CORNELL RD",
            "address_2": "STE 450",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970064810",
            "telephone_number": "503-629-5300",
            "fax_number": "503-690-9452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURGIN",
        "first_name": "ERIC",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-13",
        "last_updated": "2009-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OR",
            "license": "D9145",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaverton, OR

Sources for this page

Verify at the official NPI Registry.