Cornell Family Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D9474 Issued in OR

Legal business name

CORNELL FAMILY DENTAL

Practice address

12889 NW Cornell Rd
Portland, OR 97229

Phone

(503) 643-6643

NPI assigned

Aug 29, 2012

Last updated

Jun 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Lindsay Irene Freed, DMDNPI 1578877528

Title

Owner/Dentist

Phone

(503) 260-4296

Specialties & licenses 1

Addresses

Other names 1

• Lindsay Freed Brown Former legal business name

Locations

Practitioners 2

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.

• Lindsay Irene Freed, D.M.D.

  • General Practice Dentistry
  • Portland, OR
  • NPI 1578877528
  NPD Authorized official
• Gwen Hryciw Eichenbaum, DMD, PHD

  • General Practice Dentistry
  • Portland, OR
  • NPI 1811625569
  NPD (past)

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

{
    "created_epoch": "1346198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686700800000",
    "number": "1871841429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12889 NW CORMELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97229",
            "telephone_number": "503-643-6643",
            "fax_number": "503-644-5972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12889 NW CORNELL RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97229",
            "telephone_number": "503-643-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELL FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-29",
        "last_updated": "2023-06-14",
        "certification_date": "2023-06-14",
        "status": "A",
        "authorized_official_last_name": "FREED",
        "authorized_official_first_name": "LINDSAY",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "503-260-4296",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D9474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lindsay Freed Brown",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Brandon J Cornejo, MD, PH.D.
• Amanda Williams Cornelius, SLP
• Selena Marie Cornelius
• Richard A Corneliuz, CPFT
• Cornell Eyecare Group, Inc (Cornell Eyecare Group)
• Cornell Family Medicine
• Alexandra Gately Cornell, M.D.
• Corner Health Medical Group Northwest, P.C.
• Cornerstone Care Option
• Cornerstone Care Option, Inc. (Cornerstone Residential Option)

• General Practice Dentistry in Portland, OR
• Providers in Portland, 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 Jun 14, 2023; 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.