PORTLAND DENTAL ANESTHESIA (NPI# 1639604689) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639604689 |
| Entity Type | Organization |
| Organization Name | PORTLAND DENTAL ANESTHESIA |
| Practice Address |
21370 Sw Langer Farms Pkwy #142 Sherwood OR 97140-9137 |
| Practice Telephone | 5038584880 |
| Practice Fax Number | 5039146685 |
| Mailing Telephone | 5038584880 |
| Mailing Fax Number | 5039146685 |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-04-27 |
| Authorized Official Name | DR. RYAN T ALLRED (OWNER) |
| Authorized Official Telephone | 5038584880 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223D0004X |
Dentist Specialization: Dentist Anesthesiologist |
D9387 | OR | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PORTLAND DENTAL ANESTHESIA LLC | 21370 Sw Langer Farms #142, Sherwood, OR 97140 |
| Street Address |
21370 SW LANGER FARMS PKWY #142 |
| City | SHERWOOD |
| State | OR |
| Zip Code | 97140-9137 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457902744 | Barbara Jo Morgan | Technician | 17752 Sw Inkster Dr., Sherwood, OR 97140 | 2019-09-27 |
| 1588193031 | Brett Matthew Hulbert | Student in an Organized Health Care Education/Training Program | 17193 Sw Terrapin Dr. #106, Sherwood, OR 97140 | 2017-06-08 |
| 1083157416 | Lisa Pauline Knudsen | Counselor | 20512 Sw Roy Rogers Rd, Suite 150, Sherwood, OR 97140 | 2016-12-03 |
| 1982056479 | Mari Heslinga | Dentist | 21332 Sw Langer Farms Pkwy Ste 126, Sherwood, OR 97140 | 2016-07-07 |
| 1649634668 | Sheila Johnson | Specialist | 15885 Sw Springtooth Ln, Sherwood, OR 97140 | 2016-04-06 |
| 1649640335 | Northwest Neurohealth LLC | Clinical Neuropsychologist | 501 N. Villa Road, Newberg, OR 97140 | 2015-10-07 |
| 1366841785 | Tae Yoon | Pharmacist | 21320 Sw Langer Farms Parkway, Sherwood, OR 97140 | 2014-08-21 |
| 1396155701 | Wal-mart Stores, Inc | Technician/Technologist | 21320 Sw Langer Farm, Sherwood, OR 97140 | 2014-05-07 |
| 1588916662 | Stacey Lynn Ritala | Dental Hygienist | 15962 Sw Tualatin-sherwood Rd., Sherwood, OR 97140 | 2012-10-12 |
| 1518219310 | Peggy Ann Lewelling | Dental Hygienist | 15962 Sw Tualatin-sherwood Rd, Sherwood, OR 97140 | 2012-10-04 |
| Find all providers in zip 97140 | ||||
| Taxonomy Code | 1223D0004X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Dentist Anesthesiologist |
| A dentist who has successfully completed an accredited postdoctoral anesthesiology residency training program for dentists of two or more years duration, in accord with Commission on Dental Accreditation’s Standards for Dental Anesthesiology Residency Programs, and/or meets the eligibility requirements for examination by the American Dental Board of Anesthesiology. |
| Notes: Source: The American Society of Dentist Anesthesiologists [1/1/2013: new] |
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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.