Timber Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

TIMBER DENTAL

Practice address

3500 NE Martin Luther King Jr Blvd
Portland, OR 97212-2093

Phone

(503) 765-7355

NPI assigned

Feb 13, 2019

Organization subpart

No

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

Authorized official

Name

Ryan Berg

Title

Billing Coordinator

Phone

(503) 419-6288

Specialties & licenses 1

Addresses

Other identifiers 8

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

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560211200000",
    "number": "1992261192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 NE MARTIN LUTHER KING JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972122093",
            "telephone_number": "503-765-7355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 NE MARTIN LUTHER KING JR BLVD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972122093",
            "telephone_number": "503-765-7355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMBER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-13",
        "last_updated": "2019-06-11",
        "status": "A",
        "authorized_official_last_name": "BERG",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "BILLING COORDINATOR",
        "authorized_official_telephone_number": "503-419-6288"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1821225442",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1952684169",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1780605287",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1851845036",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1033404751",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144213802",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1295143212",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639504715",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brittany Tilton
• Sheryl L. Tilton, LMT
• Pamelah Doris Tilus, M.S.
• Tim a. Perez, LLC
• Tim Foulke Ms, Pmhnp PC
• Timber Dental - Lombard
• Timber Dental Bethany
• Timber Dental Downtown LLC
• Timber Dental East Burnside
• Timber Dental LLC

• 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 Jun 11, 2019; 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.