PETTYGROVE DENTAL LLC NPI 1558801597

Dentist (General Practice) in Portland, OR

NPI 1558801597 Organization Dentist General Practice

About PETTYGROVE DENTAL LLC

Pettygrove Dental Llc is a provider established in Portland, Oregon specializing in dentist (general practice) . The NPI number of Pettygrove Dental Llc is 1558801597 and was assigned on February 2017. The practitioner's primary taxonomy code is 1223G0001X with license number D9708 (OR). The provider is registered as an organization and their NPI record was last updated 5 years ago. Pettygrove Dental Llc operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Carmel Dudley Doran D.d.s. (Dentist)

A dentist like Pettygrove Dental Llc is a skilled in and licensed provider that diagnoses and treats problems with patients teeth, gums, and related parts of the mouth. Dentists educate patients on how to take care of the teeth and gums and provide information on diet choices that affect oral health. Dentists must be licensed in the state in which they work.

NPI

1558801597

Provider NamePETTYGROVE DENTAL LLC
Provider Location Address2267 NW PETTYGROVE ST PORTLAND, OR 97210
Provider Mailing Address2267 NW PETTYGROVE ST PORTLAND, OR 97210
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date02-23-2017
Last Update Date02-23-2017


Primary Taxonomy

Taxonomy Code1223G0001X
ClassificationDentist
TypeDental Providers
SpecializationGeneral Practice
License No.D9708
License StateOR
Taxonomy DescriptionA general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Business Address

PETTYGROVE DENTAL LLC
2267 NW PETTYGROVE ST
PORTLAND, OR
ZIP 97210
Phone: (503) 224-6317

Get Directions


Mailing Address

PETTYGROVE DENTAL LLC
2267 NW PETTYGROVE ST
PORTLAND, OR
ZIP 97210
Phone: (503) 224-6317



Authorized Official

Authorized Official NameDR. CARMEL DUDLEY DORAN D.D.S.
Authorized Official TitleDENTIST
Authorized Official Phone(503) 224-6317

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1619901279MS. JANET LEWIS LCSW
Individual
Social Worker (Clinical)2267 NW PETTYGROVE ST
PORTLAND, OR 97210
(503) 294-1075
1801815931 CRAIG C. BENBEN D.M.D.
Individual
Dentist (General Practice)2267 NW PETTYGROVE ST
PORTLAND, OR 97210
(503) 224-6317
1811177710 MONNE SMITH LICENSED COUNSELOR
Individual
Counselor (Mental Health)2267 NW PETTYGROVE ST
PORTLAND, OR 97210
(503) 730-7935
1902067077DR. CARMEL DUDLEY DORAN DDS
Individual
Dentist (General Practice)2267 NW PETTYGROVE ST
PORTLAND, OR 97210
(503) 224-6317

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.