NPIMap

Organization Active NPI

Stonebrook Family Dental, LLC

  • Dental Clinic/Center
  • Forest Grove, OR
National Provider Identifier
1982208559
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
STONEBROOK FAMILY DENTAL, LLC
Practice address
2236 Pacific Ave
Forest Grove, OR 97116-2448
Phone
(503) 359-5481
NPI assigned
Nov 24, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Authorized official

Name
Dr. Robert Lyle McCullough, D.M.DNPI 1164926788
Title
Owner
Phone
(503) 964-8909

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

2236 Pacific Ave
Forest Grove, OR 97116-2448

Mailing address

7647 SW 189TH Ave
Beaverton, OR 97007-7607
Phone (503) 964-8909

National Provider Directory

National Provider Directory

Locations

2236 Pacific Ave
Forest Grove, OR 97116
Phone (503) 359-5481

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606176000000",
    "number": "1982208559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7647 SW 189TH AVE",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970077607",
            "telephone_number": "503-964-8909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2236 PACIFIC AVE",
            "city": "FOREST GROVE",
            "state": "OR",
            "postal_code": "971162448",
            "telephone_number": "503-359-5481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STONEBROOK FAMILY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-24",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A",
        "authorized_official_last_name": "MCCULLOUGH",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LYLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-964-8909",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Grove, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 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.