Active NPI
Raymond Bernard Tucker, DDS
- Pediatric Dentistry
- Portland, OR
National Provider Identifier
1841585593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- S6-195C
- Practice address
- 8931 SE Foster Rd
Portland, OR 97266-4661 - Phone
- (855) 433-6825
- NPI assigned
- Jun 10, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | D9930 | OR | |
| Pediatric Dentistry | 1223P0221X | S6-195C | NV | Primary |
Addresses
Primary practice location
8931 SE Foster Rd
Portland, OR 97266-4661
Mailing address
353 E Bonneville Ave Unit 720
Las Vegas, NV 89101-6662
Phone (719) 210-8901
Other practice location 1
1320 NE 106th Ave
Portland, OR 97220-3966
Phone (503) 255-5448
Other practice location 2
405 SE 133rd Ave
Portland, OR 97233-1809
Phone (855) 433-6825
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S6-195C | NV | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307664000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622592000000",
"number": "1841585593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "353 E BONNEVILLE AVE UNIT 720",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891016662",
"telephone_number": "719-210-8901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8931 SE FOSTER RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972664661",
"telephone_number": "855-433-6825"
}
],
"practiceLocations": [
{
"address_1": "1320 NE 106th Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972203966",
"country_code": "US",
"telephone_number": "503-255-5448",
"fax_number": "503-256-1501",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "405 SE 133rd Ave",
"address_purpose": "LOCATION",
"city": "Portland",
"state": "OR",
"postal_code": "972331809",
"country_code": "US",
"telephone_number": "855-433-6825",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "TUCKER",
"first_name": "RAYMOND",
"middle_name": "BERNARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-10",
"last_updated": "2021-06-02",
"certification_date": "2021-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OR",
"license": "D9930",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NV",
"license": "S6-195C",
"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 Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.