O'Sama Shahadeh Betrous, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN015356 Issued in GA

Practice address

12661 SE Powell Blvd Ste D
Portland, OR 97236-3400

Phone

(503) 760-7983

NPI assigned

Nov 14, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Dental PC

  • Dentist
  • Portland, OR
  • NPI 1700982451
  NPD (past) Authorized official

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

{
    "created_epoch": "1226620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490745600000",
    "number": "1891949939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12661 SE POWELL BLVD STE D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363400",
            "telephone_number": "503-760-7983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12661 SE POWELL BLVD STE D",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972363400",
            "telephone_number": "503-760-7983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BETROUS",
        "first_name": "O'SAMA",
        "middle_name": "SHAHADEH",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-14",
        "last_updated": "2017-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6838",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN015356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Bethell
• Bethlehem LLC
• Ann Strachan Bethune, LPC, NCC
• Antone Bethune
• Jonathan Paul Betlinski, MD
• Betsy Gordon Acupuncture LLC
• Linda Bett, DNP, APRN, PMHNP-BC
• Rita M. Bettenburg, ND
• Daniel Bettencourt
• Jonathan David Bettencourt

• 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 Mar 29, 2017; 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.