NPIMap

Organization Active NPI

Life Bloom Dental LLC

  • Dental Clinic/Center
  • Portland, OR
National Provider Identifier
1821654146
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
LIFE BLOOM DENTAL LLC
Practice address
11786 SW Barnes Rd Ste 340
Portland, OR 97225-5930
Phone
(503) 646-4600
NPI assigned
May 13, 2019
Last updated
May 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

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

Authorized official

Name
Dr. Daniel Cho, DMDNPI 1205277118
Title
Owner Dentist
Phone
(971) 222-6511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X NU Primary

Addresses

Primary practice location

11786 SW Barnes Rd Ste 340
Portland, OR 97225-5930

Mailing address

11786 SW Barnes Rd Ste 340
Portland, OR 97225-5930
Phone (503) 646-4600

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557705600000",
    "number": "1821654146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11786 SW BARNES RD STE 340",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255930",
            "telephone_number": "503-646-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11786 SW BARNES RD STE 340",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972255930",
            "telephone_number": "503-646-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BLOOM DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A",
        "authorized_official_last_name": "CHO",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "971-222-6511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "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 13, 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.