DECA DENTISTRY (NPI# 1124548235) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124548235 |
| Entity Type | Organization |
| Organization Name | DECA DENTISTRY |
| Practice Address |
501 Ne Hood Ave Ste 235 Gresham OR 97030-7346 |
| Mailing Address |
501 Ne Hood Ave Ste 235 Gresham OR 97030 |
| Practice Telephone | 5036614900 |
| Mailing Telephone | 5036614900 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2018-03-17 |
| Authorized Official Name | DR. BEATRICE DECA (DENTIST/ OWNER) |
| Authorized Official Telephone | 5032679400 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223E0200X |
Dentist Specialization: Endodontics |
D10376 | OR | Dental Providers |
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
D10377 | OR | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5440 Sw Westgate Dr Ste 165, Portland, OR 972212421 | 5032679400 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | DECA DENTISTRY | 501 Ne Hood Ave Suite 235, Gresham, OR 97030 |
| Street Address |
501 NE HOOD AVE STE 235 |
| City | GRESHAM |
| State | OR |
| Zip Code | 97030-7346 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982772026 | Cristina Pellicano Kennedy | Dentist | 501 Ne Hood Ave Ste 235, Gresham, OR 97030-7346 | 2006-11-30 |
| 1417186990 | Beatrice E Deca | Dentist | 501 Ne Hood Ave Ste 235, Gresham, OR 97030-7346 | 2009-07-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174032312 | Tiffany Chen | Occupational Therapist | 304 Ne Hood Ave., Gresham, OR 97030 | 2017-09-20 |
| 1225568454 | Goldstar Vascular Access, Inc | Home Infusion | 2870 Ne Hogan Dr, Ste E #205, Gresham, OR 97030 | 2017-06-20 |
| 1861940454 | Jessica Morrow | Massage Therapist | 1748 Nw Fairview Dr., Gresham, OR 97030 | 2016-09-13 |
| 1033665898 | Bonita Baxter | Counselor | 400 Ne 7th Street, Gresham, OR 97030 | 2016-08-31 |
| 1710335484 | Ethan William Hoccom | Counselor | 1527 Ne Lamesa Place 17th St, Gresham, OR 97030 | 2016-06-02 |
| 1992159610 | Kathleen Kline, Lmt | Massage Therapist | 1217 Ne Burnside Road Suite 701-d, Gresham, OR 97030 | 2016-04-19 |
| 1215390109 | The Wallace Medical Concern | Nurse Practitioner | 254 Nw Burnside Road, Gresham, OR 97030 | 2016-03-30 |
| 1932568912 | Atchison Dialysis, LLC | Clinic/Center | 878 Nw Burnside Rd, Gresham, OR 97030 | 2016-02-18 |
| 1912374034 | Hilary Dawn Montgomery | Counselor | 1326 Nw Civic Dr # 5569, Gresham, OR 97030 | 2015-08-24 |
| 1992171730 | Melissa E Childs | Massage Therapist | 1217 Nw Burnside Rd Ste 701, Gresham, OR 97030 | 2015-08-17 |
| Find all providers in zip 97030 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A 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. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083062020 | Nhu Nguyen | Dentist | 315 Nw Burnside Rd, Gresham, OR 97030-3851 | 2016-06-01 |
| 1013321587 | Matthew Vogel | Dentist | 1201 Se 223rd Ave Ste 140, Gresham, OR 97030 | 2014-06-12 |
| 1164680047 | Kurt David Fuerstenau | Dentist | 1605 Sw Walters Dr, Gresham, OR 97080-9355 | 2008-05-28 |
| 1750587085 | Gary Stewart Cooke | Dentist | 490 E Powell Blvd, Gresham, OR 97030-7610 | 2007-06-24 |
| 1073730784 | Bradley Fuller | Dentist | 2458 Se Burnside Rd, Gresham, OR 97080-1247 | 2007-04-20 |
| 1578689659 | Paynter Family Dentistry, PC | Dentist | 445 W Powell Blvd, Gresham, OR 97030-7048 | 2007-03-21 |
| 1285795690 | Vicki J Reichlein | Dentist | 2039 Ne Burnside Rd, Gresham, OR 97030-7998 | 2006-12-12 |
| 1982772026 | Cristina Pellicano Kennedy | Dentist | 501 Ne Hood Ave Ste 235, Gresham, OR 97030-7346 | 2006-11-30 |
| 1720159221 | Raymond Shigeuki Onchi | Dentist | 35 Ne Kelly Ave, Gresham, OR 97030-7539 | 2006-11-13 |
| 1598854929 | Dmitri Vladislavovich Aleksandrov | Dentist | 600 Ne 8th St Ste 210, Gresham, OR 97030-7341 | 2006-10-12 |
| Find all providers in GRESHAM | ||||
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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.