DR. CHARLES RICHARD DTALEY (NPI# 1750451555) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750451555 |
| Entity Type | Individual |
| Full Name | DR. CHARLES RICHARD DTALEY |
| Credential | DMD |
| Practice Address |
14495 Sw Allen Blvd Beaverton OR 97005-4427 |
| Mailing Address |
6950 Ne Campus Way Hillsboro OR 97124-5611 |
| Practice Telephone | 5035260318 |
| Practice Fax Number | 5036261054 |
| Mailing Telephone | 5039522164 |
| Mailing Fax Number | 5035264418 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
4879 | OR | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | OREGON HEALTH PLAN | 6783 | 01 |
| Street Address |
14495 SW ALLEN BLVD |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97005-4427 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154945053 | Krista Lowe Schimmelbusch | Student in an Organized Health Care Education/Training Program | 12730 Sw 3rd St., Beaverton, OR 97005 | 2020-06-05 |
| 1346882578 | Mireya Elissa Nunez I | Counselor | 12665 Sw Center Street, Suite 100, Beaverton, OR 97005 | 2019-10-09 |
| 1548816879 | Logan James Patzlaff | Behavior Technician | 6200 Sw Artic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-08-13 |
| 1528521424 | Alex Taylor Foerman | Behavior Technician | 6200 Sw Arctic Drive Beaverton, Or 97005, Beaverton, OR 97005 | 2019-04-09 |
| 1285193003 | Hazelnut Dental LLC | Clinic/Center | 10773 Sw Beaverton-hillsdale Hwy, Ste B, Beaverton, OR 97005 | 2019-03-19 |
| 1992286348 | Kathryn Wallner | Counselor | 14205 Sw Farmington Road, Suite 160, Beaverton, OR 97005 | 2018-08-23 |
| 1699265058 | Meaghan Mikulic | Social Worker | 14355 Sw Allen Blvd Suite 150, Beaverton, OR 97005 | 2018-05-11 |
| 1629568936 | Aimee J Nelson | Massage Therapist | 10700 Sw Beaverton Hillsdale Hwy Ste 465, Beaverton, OR 97005 | 2018-05-11 |
| 1093221780 | Ember Dahl | Massage Therapist | 12655 Sw Center St Ste 530, Beaverton, OR 97005 | 2017-12-18 |
| 1033667456 | Andre Vo | Pharmacist | 2575 Sw Walker Rd, Beaverton, OR 97005 | 2016-09-14 |
| Find all providers in zip 97005 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174677256 | Richard P Hsu | Dentist | 1789 Nw 173rd Ave, Beaverton, OR 97006 | 2007-01-23 |
| 1770584419 | Eric A Downey | Dentist | 14795 Sw Murray Scholls Dr, Suite 116, Beaverton, OR 97007-9713 | 2005-08-03 |
| 1184156952 | Chloe Mai | Dentist | 1789 Nw 173rd Ave, Beaverton, OR 97006 | 2017-03-31 |
| 1386985489 | Richard Hsu, Dm., PC | Dentist | 1789 Nw 173rd Ave, Beaverton, OR 97006-4817 | 2013-03-14 |
| 1033424411 | Ashley Puleo Schaaf | Dentist | 14795 Sw Murray Scholls Dr, Suite 116, Beaverton, OR 97007-9713 | 2010-08-10 |
| 1194953323 | Piper Lynn Huber | Dentist | 17675 Sw Tualatin Valley Hwy, Beaverton, OR 97003-4443 | 2009-06-25 |
| 1720262322 | Murrayhill Pediatric Dentistry P.C. | Dentist | 14795 Sw Murray Scholls Dr, Suite #116, Beaverton, OR 97007-9713 | 2007-12-19 |
| 1467572131 | Ronald Zirkle | Dentist | 16155 Nw Cornell Rd, Suite 450, Beaverton, OR 97006-4810 | 2007-03-29 |
| 1023028305 | Susan Jane Antony | Dentist | 17675 Sw Tualatin Valley Hwy, Beaverton, OR 97006-4443 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297279 | Dennis M Dunne Dds PC | Dentist | 1600 Executive Pkwy Ste 350, Eugene, OR 97401-7110 | 2020-02-20 |
| 1225678139 | Eric E Jacobsen Dds PC | Dentist | 19502 Molalla Ave Ste 109, Oregon City, OR 97045-4513 | 2020-01-08 |
| 1982168506 | Anthony Frank Vinciguerra | Dentist | 37315 Second St, Nehalem, OR 97131-9679 | 2019-01-28 |
| 1114493582 | Matt W Anderson Dds PC | Dentist | 2215 Willamette St Ste A, Eugene, OR 97405-3341 | 2018-10-23 |
| 1366923245 | Big Tooth Little Tooth Pediatric Dentistry PC | Dentist | 2020 8th Ave Ste 121, West Linn, OR 97068-4657 | 2018-08-28 |
| 1578057618 | Bittner & Flann LLC | Dentist | 17680 Sw Handley St Ste 201, Sherwood, OR 97140-9299 | 2018-06-21 |
| 1700374154 | Fox Kids Dentistry & Orthodontics II | Dentist | 1401 Se Morrison St Ste 120, Portland, OR 97214-2777 | 2018-05-01 |
| 1053812081 | Armin Afshar | Dentist | 201 Se Washington St Ste A, Dallas, OR 97338-2860 | 2018-02-25 |
| 1942712922 | Harmony Pediatric Dental Group LLC | Dentist | 37515 Se Hwy 26, Sandy, OR 97055 | 2017-10-30 |
| 1790225399 | Childrens Dentistry | Dentist | 515 W Idaho Ave, Ontario, OR 97914-2348 | 2017-03-01 |
| 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.