SIGNATURE OREGON DENTAL PARTNERS PC (NPI# 1114568029) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114568029 |
| Entity Type | Organization |
| Organization Name | SIGNATURE OREGON DENTAL PARTNERS PC |
| Other Organization Name | HORACEK DENTAL |
| Practice Address |
11815 Sw King James Pl Ste 10 Tigard OR 97224-2479 |
| Mailing Address |
410 N 44th St Ste 290 Phoenix AZ 85008-7622 |
| Practice Telephone | 5034338256 |
| Mailing Telephone | 4806264154 |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2020-10-02 |
| Authorized Official Name | MELODY BENNION (DIRECTOR OF INTEGRATIONS) |
| Authorized Official Telephone | 4802348490 |
| Is Organization Subpart | Y |
| Parent Organization Name | SIGNATURE DENTAL PARTNERS LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Horacek Dental | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 508 E Broadway Ave, Milton Freewater, OR 978621315 | 5419383363 | 5419383912 |
| 9211 Se Division St, Portland, OR 972661452 | 5032542068 |
| Street Address |
11815 SW KING JAMES PL STE 10 |
| City | TIGARD |
| State | OR |
| Zip Code | 97224-2479 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134143076 | Rod Johnson | Dentist | 11815 Sw King James Pl Ste 10, Tigard, OR 97224-2479 | 2006-07-26 |
| 1487784419 | Rcj Dental PC | Dentist | 11815 Sw King James Pl Ste 10, Tigard, OR 97224-2479 | 2007-03-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154973139 | Katherine Raineri | Psychologist | 7213 Sw Hazel Fern Rd, Tigard, OR 97224 | 2019-07-10 |
| 1871064618 | Stacey A Wenzel | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Rd.,suite 201, Tigard, OR 97224 | 2018-12-05 |
| 1376010090 | Meredith Rae Brezinski | Physical Therapist | 18019 Sw Boones Ferry Road, Tigard, OR 97224 | 2018-10-31 |
| 1649759358 | Viktoriya A Chiliy | Behavior Technician | 15290 Sw Royalty Parkway, Tigard, OR 97224 | 2018-08-13 |
| 1609384866 | Rachel E King | Physical Therapist | 18040 Sw Lower Boones Ferry Rd Ste 200, Tigard, OR 97224 | 2018-01-22 |
| 1689190134 | Isabelle Cooper Klee Caballero | Speech-Language Pathologist | 17020 Sw Upper Boones Ferry Road Suite 201, Tigard, OR 97224 | 2017-08-16 |
| 1427573146 | Breanna M Sandefur | Behavior Technician | 15290 Sw Royalty Pkwy, Tigard, OR 97224 | 2017-08-03 |
| 1083141196 | Krista Espenship | Registered Nurse | 8032 Sw Ashford St, Tigard, OR 97224 | 2017-05-19 |
| 1275067928 | Emily Elizabeth Myers | Behavioral Analyst | 15290 Royalty Parkway, Tigard, OR 97224 | 2017-04-19 |
| 1235684937 | Melanie Salvador | Nurse Practitioner | 15352 Sw Oakmont Pl, Tigard, OR 97224 | 2016-08-23 |
| Find all providers in zip 97224 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598285777 | Clark Oral Surgery and Implant Center | Clinic/Center | 9430 Sw Coral St Ste 200, Tigard, OR 97223-6692 | 2017-06-20 |
| 1295083509 | Joseph B Young Dmd PC | Clinic/Center | 15405 Sw 116th Ave Ste 208, Tigard, OR 97224-4101 | 2012-08-16 |
| 1093086415 | Bridgeport Dental LLC | Clinic/Center | 18035 Sw Lower Boones Ferry Rd, Tigard, OR 97224-7228 | 2012-01-17 |
| 1295798452 | Bradley S. Mcallister, Dds, Phd | Clinic/Center | 11525 Sw Durham Rd, Suite D-6, Tigard, OR 97224-3475 | 2006-04-10 |
| 1518577865 | Andrew Henderson Dmd P.C. | Clinic/Center | 9020 Sw Washington Square Rd Ste 570, Tigard, OR 97223-4477 | 2020-08-03 |
| 1790267128 | Emergency Tooth Doctor Tigard, P.C. | Clinic/Center | 14465 Sw Pacific Hwy, Tigard, OR 97224 | 2018-09-01 |
| 1265942650 | Simpson Dental Care, PC | Clinic/Center | 16035 Sw Pacific Hwy, Tigard, OR 97224-3438 | 2017-10-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144834375 | Geoffrey R Clive Dds LLC | Clinic/Center | 11082 Se Oak St, Milwaukie, OR 97222-6692 | 2020-09-04 |
| 1508416041 | Columbia River Dentistry-gresham, LLC | Clinic/Center | 1700 Nw Civic Dr Ste 320, Gresham, OR 97030-3774 | 2019-09-17 |
| 1063065068 | Portland Dental Smiles | Clinic/Center | 732 Sw 3rd Ave Ste 202, Portland, OR 97204-2409 | 2019-07-18 |
| 1104478619 | David A Allen Dds | Clinic/Center | 1059 Royal Ave, Medford, OR 97504-6127 | 2019-07-15 |
| 1750933917 | Multnomah County | Clinic/Center | 11540 Ne Inverness Dr., Inverness Jail, Portland, OR 97220 | 2019-07-09 |
| 1164080875 | Central Point Dental LLC | Clinic/Center | 12338 Se 143rd Pl, Happy Valley, OR 97086-6545 | 2019-05-29 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1558839498 | Kevin Prates Dds, PC | Clinic/Center | 1002 10th St Ste 1, Hood River, OR 97031-1564 | 2018-11-08 |
| 1063993749 | Roots Dental Stark LLC | Clinic/Center | 16338 Se Stark St, Portland, OR 97233-3958 | 2018-08-22 |
| 1528546330 | Christopher Brady Dmd LLC | Clinic/Center | 4707 Ne 102nd Ave Ste A, Portland, OR 97220-3393 | 2018-08-02 |
| Find all providers with the same taxonomy | ||||
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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.