Active NPI
Nathan G Dustin, DMD
- General Practice Dentistry
- Portland, OR
National Provider Identifier
1982792636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D7725
- Practice address
- 5071 NE 122ND Ave
Portland, OR 97230-1003 - Phone
- (503) 255-5700
- Fax
- (503) 255-2099
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D7725 | OR | Primary |
Addresses
Primary practice location
5071 NE 122ND Ave
Portland, OR 97230-1003
Mailing address
5071 NE 122ND Ave
Portland, OR 97230-1003
Phone (503) 255-5700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D7725 | OR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baseline Dental LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982792636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5071 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301003",
"telephone_number": "503-255-5700",
"fax_number": "503-255-2099"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5071 NE 122ND AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972301003",
"telephone_number": "503-255-5700",
"fax_number": "503-255-2099"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUSTIN",
"first_name": "NATHAN",
"middle_name": "G",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OR",
"license": "D7725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.