KAISER PERMANENTE DENTAL CARE PROGRAM (NPI# 1043224678) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043224678 |
| Entity Type | Organization |
| Organization Name | KAISER PERMANENTE DENTAL CARE PROGRAM |
| Practice Address |
12711 Se Mill Plain Blvd Vancouver WA 98684-6053 |
| Mailing Address |
510 W 34th St Vancouver WA 98660-1811 |
| Practice Telephone | 3608964484 |
| Mailing Telephone | 3606957208 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. JODEEN CALLAGHAN (PROFESSIONAL DIRECTOR, CASCADE PARK) |
| Authorized Official Telephone | 3608964484 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | DH00004025 | WA | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861918005 | Kaiser Permanente Dental Care Program | Dental Hygienist | 2930 Ne Dekum St, Portland, OR 97211-6613 | 2017-08-18 |
| Street Address |
12711 SE MILL PLAIN BLVD |
| City | VANCOUVER |
| State | WA |
| Zip Code | 98684-6053 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479094 | Rosalyn Ellen Lamb | Dental Hygienist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2019-10-24 |
| 1447714399 | Rimma Feldeshi | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2019-01-24 |
| 1477029908 | Lydia Kay Lyall | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2018-10-23 |
| 1891247029 | Kaiser Foundation Health Plan of The Northwest | Dentist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-11-04 |
| 1033669833 | Charity Rebecca Ashworth | Dental Hygienist | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-10-05 |
| 1003277104 | Svetlana Anenko | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-03-16 |
| 1720449937 | Renee Mcqueen | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2016-03-15 |
| 1124497433 | Hilary Lee Beatty | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2015-09-16 |
| 1942699376 | Kristina Santiago | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2015-01-22 |
| 1467856013 | Amy Herzog | Dental Assistant | 12711 Se Mill Plain Blvd, Vancouver, WA 98684-6053 | 2014-10-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285291849 | Pacifica Sylvan Park LLC | Alzheimer Center (Dementia Center) | 2400 Ne 112th Avenue, Vancouver, WA 98684 | 2019-05-20 |
| 1699242826 | Heidi Ericka Jackson | Registered Nurse | 15606 Ne 12th Way, Vancouver, WA 98684 | 2018-10-25 |
| 1477076727 | Brian Benasa Bardeloza | Dentist | 605 Se 164th Ave Ste 103, Vancouver, WA 98684 | 2017-07-19 |
| 1992226062 | Judith Moreno-castro | Massage Therapist | 2501 Ne 138th Ave., #60, Vancouver, WA 98684 | 2017-06-29 |
| 1346790706 | Samuel Joonsang Lee | Registered Nurse | 501 Se 172nd Ave Ste 210, Vancouver, WA 98684 | 2016-10-10 |
| 1912353178 | Cheryl A. Hamilton-jefferson | Counselor | 11818 Se Mill Plain Blvd Ste 311g, Vancouver, WA 98684 | 2016-05-06 |
| 1063866424 | Kim Forgione | Optometrist | 1900 Ne 162nd Ave Ste D103, Vancouver, WA 98684 | 2016-04-21 |
| 1700254257 | Desiree Haggart | Registered Nurse | 406 Se 131st St., Suite A101, Vancouver, WA 98684 | 2015-09-14 |
| 1215318068 | Paige M. King | Behavioral Analyst | 11818 Se Mill Plain Blvd Ste 203, Vancouver, WA 98684 | 2015-06-17 |
| 1417354366 | Amanda Hilkey, Lmp | Massage Therapist | 108 Se 24th Ave, Ste 9, Vancouver, WA 98684 | 2014-11-20 |
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| Taxonomy Code | 124Q00000X |
| Grouping | Dental Providers |
| Classification | Dental Hygienist |
| An individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental examiners to provide preventive care services under the supervision of a dentist. Functions that may be legally delegated to the dental hygienist vary based on the needs of the dentist, the educational preparation of the dental hygienist and state dental practice acts and regulations, but always include, at a minimum, scaling and polishing the teeth. To avoid misleading the public, no occupational title other than dental hygienist should be used to describe this dental auxiliary. |
| Notes: Source: Comprehensive Policy Statement on Dental Auxiliaries, American Dental Association. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053946673 | Jessica Maree Carnes | Dental Hygienist | 6505 Nw Cherry Street, Vancouver, WA 98663 | 2020-03-04 |
| 1891267860 | Ronita Smith | Dental Hygienist | 9506 Ne 161st Ave, Vancouver, WA 98682-1866 | 2019-01-01 |
| 1477088920 | Alexandra Ransonet | Dental Hygienist | 19111 Se 34th. St., Vancouver, WA 98683 | 2017-04-21 |
| 1124560545 | Shauna Weil | Dental Hygienist | 8909 Ne 136th Ave, Vancouver, WA 98682-3059 | 2016-11-16 |
| 1114478039 | Madeline Jean Larson | Dental Hygienist | 4205 Ne 130th Ave, Vancouver, WA 98682-6855 | 2016-10-14 |
| 1346608585 | Brittany Wilson | Dental Hygienist | 14013 Ne 31st Ct, Vancouver, WA 98686-2256 | 2016-02-03 |
| 1588022776 | Diane Hazell | Dental Hygienist | 2621 Ne 134th St Ste 300, Vancouver, WA 98686-3036 | 2016-02-03 |
| 1093173213 | Sara Frances Diaz | Dental Hygienist | 10617 Nw Lakeshore Ave, Vancouver, WA 98685-4766 | 2016-02-02 |
| 1003291527 | Jennifer Ficco | Dental Hygienist | 910 Ne Tenney Rd, Suite 117, Vancouver, WA 98685-2837 | 2015-07-27 |
| 1801271218 | Luiza Ghitea | Dental Hygienist | 17703 Ne 38th Way, Vancouver, WA 98682-3683 | 2015-07-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.