NPIMap

Organization Active NPI

First Impressions Denture Studio

  • Denturist
  • Portland, OR
National Provider Identifier
1992307367
Registry record updated Feb 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
Legal business name
FIRST IMPRESSIONS DENTURE STUDIO
Practice address
200 NE 20TH Ave Ste 100
Portland, OR 97232-3094
Phone
(503) 230-0207
Fax
(503) 230-0208
NPI assigned
Nov 11, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2022

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

Authorized official

Name
David PettitNPI 1124620802
Title
Operations Director
Phone
(503) 230-0207

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
DenturistGroup: 193400000X SINGLE SPECIALTY GROUP 122400000X Primary

Addresses

Primary practice location

200 NE 20TH Ave Ste 100
Portland, OR 97232-3094

Mailing address

200 NE 20TH Ave Ste 100
Portland, OR 97232-3094
Phone (503) 230-0207

Other names 2

  • First Impressions Denture Studio Doing business as
  • Melanie Block Licensed Denturist Doing business as

National Provider Directory

National Provider Directory

Locations

200 NE 20th Ave
Ste 100
Portland, OR 97232
Phone (503) 230-0207

Practitioners & affiliated clinicians

Practitioners 2

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": "1605052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645401600000",
    "number": "1992307367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE 20TH AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323094",
            "telephone_number": "503-230-0207",
            "fax_number": "503-230-0208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE 20TH AVE STE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323094",
            "telephone_number": "503-230-0207",
            "fax_number": "503-230-0208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRST IMPRESSIONS DENTURE STUDIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-11",
        "last_updated": "2022-02-21",
        "certification_date": "2022-02-21",
        "status": "A",
        "authorized_official_last_name": "PETTIT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "503-230-0207"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Denturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "First Impressions Denture Studio",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Melanie Block Licensed Denturist",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 21, 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.