ROOTS DENTAL STARK LLC (NPI# 1063993749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063993749 |
| Entity Type | Organization |
| Organization Name | ROOTS DENTAL STARK LLC |
| Other Organization Name | ROOTS DENTAL |
| Practice Address |
16338 Se Stark St Portland OR 97233-3958 |
| Practice Telephone | 9712941399 |
| Mailing Telephone | 5039122600 |
| Enumeration Date | 2018-08-22 |
| Last Update Date | 2019-09-20 |
| Authorized Official Name | RYAN SMITH (MANAGER) |
| Authorized Official Telephone | 5039122600 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
D9728 | OR | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Roots Dental | Doing Business As Name - Organization |
| Street Address |
16338 SE STARK ST |
| City | PORTLAND |
| State | OR |
| Zip Code | 97233-3958 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205448164 | Moore Therapy Services, LLC | Behavioral Analyst | 2053 Se 181st Ave, Portland, OR 97233 | 2020-08-20 |
| 1427563733 | Central City Concern Inc | Clinic/Center | 1415 Se 122nd Ave, Portland, OR 97233 | 2017-12-08 |
| 1427573443 | Sunshine Ahc | In Home Supportive Care | 2217 Se 156th Ave, Portland, OR 97233 | 2017-08-10 |
| 1538609433 | Nathaniel Davis Jr. | Counselor | 8915 Se Center St, Tigard, OR 97233 | 2017-02-27 |
| 1154878627 | Oregon Outreach Inc | Case Management | 1740 South East 139th Avenue, Portland, OR 97233 | 2016-09-01 |
| 1023461019 | Julianne Baltzley | Counselor | 2409 Se 149th Avenue, Portland, OR 97233 | 2016-07-14 |
| 1710332143 | Emma Slater | Counselor | 12360 Se Burnside, Portland, OR 97233 | 2016-05-04 |
| 1245621952 | Gregory Brett Bledsoe | Counselor | 1427 Se 182nd Ave., Portland, OR 97233 | 2015-02-17 |
| 1396149852 | Jacqueline Bension | Counselor | 1705 Se 122nd Ave, Portland, OR 97233 | 2014-10-13 |
| 1700206950 | Olga I Zlatova I | Dental Hygienist | 325 Se 154th Ave, Portland, OR 97233 | 2014-04-25 |
| Find all providers in zip 97233 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430711 | Md Portland LLC | Clinic/Center | 15 Middle St # A-c2, Portland, ME 04101-4881 | 2020-05-29 |
| 1598396350 | Roots Dental, Pllc | Clinic/Center | 191 Marginal Way Ste C, Portland, ME 04101-3387 | 2020-01-30 |
| 1063065068 | Portland Dental Smiles | Clinic/Center | 732 Sw 3rd Ave Ste 202, Portland, OR 97204-2409 | 2019-07-18 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1528546330 | Christopher Brady Dmd LLC | Clinic/Center | 4707 Ne 102nd Ave Ste A, Portland, OR 97220-3393 | 2018-08-02 |
| 1124511191 | Enk Dental PC | Clinic/Center | 6516 Ne Siskiyou St, Portland, OR 97213-4572 | 2018-06-13 |
| 1760997654 | Gary S Hongo Dmd, LLC | Clinic/Center | 9732 Se Washington St Ste H, Portland, OR 97216-8405 | 2017-12-13 |
| 1689183717 | Kai-uwe H. Hahn Dmd Dba Edelweiss Dental | Clinic/Center | 3503 N Lombard Street, Portland, OR 97217 | 2017-09-20 |
| 1962930362 | Alaniz Family & Cosmetic Dentistry, PC | Clinic/Center | 11701 Se Stark St, Portland, OR 97216-3759 | 2017-05-30 |
| 1902277551 | Hollywood Family Dentistry | Clinic/Center | 1735 Ne 40th Ave, Portland, OR 97212-5307 | 2015-10-08 |
| Find all providers in PORTLAND | ||||
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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.