Vancouver DG LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

VANCOUVER DG LLC

Practice address

1185 NW 178TH Ave
Beaverton, OR 97006-3364

Phone

(971) 708-9540

NPI assigned

Aug 11, 2022

Last updated

Aug 11, 2022By 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

Ryan Smith, DDS

Title

Manager

Phone

(971) 708-9540

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1660176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660176000000",
    "number": "1972231413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 NW 178TH AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970063364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1185 NW 178TH AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970063364",
            "telephone_number": "971-708-9540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VANCOUVER DG LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-11",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "971-708-9540",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jillian Lucille Van Staaveren, DPT
• Taryn Weslie Van Vliet
• Kyle H. Van, D.D.S.
• Thao Van, PA
• Joseph Elias Vance, D.C.
• Margaret S. Vandenbark, M.D.
• Alisa Vanderzalm, MSW
• Meghan Siobhan Vandewettering, MD
• Mark James Vandusen, DMD
• Vanguard Performance Rehab LLC

• Dental Clinic/Center in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Dental Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; 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.