Benjamin Pham, DMD

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D10575 Issued in OR

Practice address

2020 8TH Ave Ste 121
West Linn, OR 97068-4657

Phone

(503) 305-6505

NPI assigned

Sep 14, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Big Tooth Little Tooth Pediatric Dentistry PC

  • Pediatric Dentistry
  • West Linn, OR
  • NPI 1366923245
  NPD (past) Authorized official
• Pediatric Dentistry of West Linn

  • Pediatric Dentistry
  • West Linn, OR
  • NPI 1346607363
  NPD (past)

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

{
    "created_epoch": "1379116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1922434562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE 121",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-305-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 8TH AVE STE 121",
            "city": "WEST LINN",
            "state": "OR",
            "postal_code": "970684657",
            "telephone_number": "503-305-6505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "387 NE 223rd Ave",
            "address_purpose": "LOCATION",
            "city": "Gresham",
            "state": "OR",
            "postal_code": "970308554",
            "country_code": "US",
            "telephone_number": "503-491-5436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-14",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "64392",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056971-1",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D10575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03818279",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Peters, M.A., CCC-SLP
• Jeanie Elizabeth Petersen
• Lael R Petersen, LCSW
• Rita Petersen
• Gerald Dudley Peterson, DPM
• Linda Pham, L.M.T.
• Lynne Christine Piazza-Vitek, LMT
• Megan Pierson, PT, DPT
• Maddison Rylie Pitzl
• Point of Action Physical Medicine LLC

• Pediatric Dentistry in West Linn, OR
• Providers in West Linn, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.