BRYAN CLEVENGER DDS
NPI 1780065128
Dentist - Oral and Maxillofacial Surgery in Tigard, OR

Q: What is Bryan Clevenger's NPI number?

The NPI number for Bryan Clevenger is 1780065128. It was assigned to this individual provider in the NPPES registry on June 11, 2015.

Q: What is Bryan Clevenger's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Oral and Maxillofacial Surgery, with taxonomy code 1223S0112X.

Q: Is Bryan Clevenger enrolled in Medicare?

No. Bryan Clevenger has opted out of Medicare through January 6, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

Q: When was this NPI record last updated?

The NPPES record for Bryan Clevenger was last updated on September 30, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 11, 2015Opted out of Medicare · through Jan 6, 2027

7095 SW GONZAGA ST, TIGARD, OR 97223(855) 433-6825 Get Directions Write a Review

NPPES record last updated: September 30, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Sep 30, 2020, Jul 17, 2019 (2 updates tracked since 2019).

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About Bryan Clevenger Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BRYAN CLEVENGER DDS (NPI 1780065128) is an individual oral and maxillofacial surgery provider in Tigard, Oregon, licensed in Oregon (D11035) and active in the NPI registry since June 2015. He has opted out of Medicare through January 6, 2027 and remains eligible to order and refer and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1780065128

Entity TypeIndividualMale

Primary Taxonomy1223S0112X

Provider Legal NameBRYAN CLEVENGERCredential: DDS

Location Address7095 SW GONZAGA STTigard, OR 97223-8309

Mailing Address6950 Ne Campus WayHillsboro, OR 97124-5611 · (855) 433-6825

Phone(855) 433-6825

Sole ProprietorYes

Enumeration DateJune 11, 2015

Last NPPES UpdateSeptember 30, 20202 updates tracked since enumeration

NPPES CertifiedSeptember 30, 2020

✔ NPI 1780065128 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · Oral and Maxillofacial SurgeryDental Providers

Taxonomy Code1223S0112X

License✔ Licensed in OR · D11035

Definition

An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

7095 SW GONZAGA ST, Tigard, OR 97223

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Secondary Practice Locations 2

Location 17703 Floyd Curl DrSan Antonio, TX 78229-3901 · Phone (210) 567-7000

Location 21625 E McAndrews Rd Ste AMedford, OR 97504 · Phone (541) 779-3781 · Fax (541) 779-6523

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Bryan Clevenger Dds has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 6, 2023 through January 6, 2027.

Opt-Out Effective DateJanuary 6, 2023

Opt-Out In Effect ThroughJanuary 6, 2027Opt-out affidavits renew automatically every two years unless cancelled

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 97223 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$90.51 typical visit price

range $58.99 – $176.88

Typical copayment $22.62 (range $14.74 – $44.22)

Most-billed visit code 99203

Established Patient

$73.28 typical visit price

range $19.32 – $144.79

Typical copayment $18.32 (range $4.83 – $36.19)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DEAN ROY GRETZINGER DDS

Dentist