Individual provider Active NPI

Elizabeth Anh Smith Takamori, DDS, MS

  • Dentist
  • Salem, OR
National Provider Identifier
1871867671
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D10165 Issued in OR
Practice address
5135 Skyline Rd S
Salem, OR 97306-9427
Phone
(503) 588-6506
NPI assigned
Feb 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D10165 OR Primary
Dentist 122300000X 60690 CA
Dentist 122300000X DE60402594 WA

Addresses

Primary practice location

5135 Skyline Rd S
Salem, OR 97306-9427

Mailing address

5135 Skyline Rd S
Salem, OR 97306-9427
Phone (503) 588-6506

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
I20160106002760 OR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9739481854

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
60690CAMDDentist
D10165ORMDDentist
DE60402594WAMDDentist
10165ORMDMassage Therapist

NPI Registry JSON

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

{
    "created_epoch": "1330300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475193600000",
    "number": "1871867671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5135 SKYLINE RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069427",
            "telephone_number": "503-588-6506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5135 SKYLINE RD S",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973069427",
            "telephone_number": "503-588-6506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKAMORI",
        "first_name": "ELIZABETH",
        "middle_name": "ANH SMITH",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-27",
        "last_updated": "2016-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10165",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "60690",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE60402594",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

Verify at the official NPI Registry.