Woodburn Modern Dental LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WOODBURN MODERN DENTAL LLC

Practice address

1641 Mount Hood Ave
Woodburn, OR 97071-9070

Phone

(713) 927-5101

NPI assigned

Aug 7, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Jabal Patel, DMD

Title

Co-Owner

Phone

(847) 224-3846

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1565136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1821643693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1641 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719070",
            "telephone_number": "503-305-2525",
            "fax_number": "503-305-2526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1641 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719070",
            "telephone_number": "713-927-5101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODBURN MODERN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-07",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "JABAL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "847-224-3846",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Woodburn Community Dental
• Woodburn Cosmetic & Family Dentistry P.C.
• Woodburn Dental Group, P.C.
• Woodburn Eye Center, LLC
• Woodburn Health Center Pharmacy
• Woodburn Pediatric Clinic
• Woodburn Pediatric Clinic LLP
• Megan Jean Wooldridge, LMT
• Yakim Valley Farm Workers Clinic
• Yakim Valley Farm Workers Clinic

• General Practice Dentistry in Woodburn, OR
• Providers in Woodburn, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; 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.