POWELL DENTAL SPECIALTIES (NPI# 1306183074) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306183074 |
| Entity Type | Organization |
| Organization Name | POWELL DENTAL SPECIALTIES |
| Practice Address |
12661 Se Powell Blvd Ste D Portland OR 97236-3400 |
| Practice Telephone | 5037601880 |
| Practice Fax Number | 5037756849 |
| Mailing Telephone | 5037601880 |
| Mailing Fax Number | 5037756849 |
| Enumeration Date | 2013-01-14 |
| Last Update Date | 2013-01-14 |
| Authorized Official Name | DR. TONY GABY BASSILI (ENDODONTIST) |
| Authorized Official Telephone | 5034323997 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
D7799 | OR | Dental Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | POWELL DENTAL SPECIALTIES PROFESSIONAL CORPORATION | 4392 Liberty Rd S, Salem, OR 97302 |
| Street Address |
12661 SE POWELL BLVD STE D |
| City | PORTLAND |
| State | OR |
| Zip Code | 97236-3400 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891949939 | O'sama Shahadeh Betrous | Dentist | 12661 Se Powell Blvd Ste D, Portland, OR 97236-3400 | 2008-11-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336650357 | Wondmimu Edao Chako | Registered Nurse | 3708 Se 144th Avenue, Portland, OR 97236 | 2017-10-17 |
| 1881142388 | John Ho | Pharmacist | 14700 Se Division St., Portland, OR 97236 | 2016-09-14 |
| 1306392527 | Lori-ann Lima | Nurse Practitioner | Multnomah County Health Department- Mid Cty Health Ctr, 12710 Se Division St, Portland, OR 97236 | 2016-08-28 |
| 1982096202 | Allan Fitzpatrick Beals-gibson | Adult Companion | 15602 Se Division St., Portland, OR 97236 | 2015-02-24 |
| 1386047132 | Columbiacare Services | Community Based Residential Treatment Facility, Mental Illness | 3530 Se 136th Ave. #5, Portland, OR 97236 | 2014-10-07 |
| 1356750319 | Kendra Harding | Counselor | 17214 Se Division Street, Portland, OR 97236 | 2014-08-04 |
| 1659790400 | Nghia Tran | Pharmacist | 8438 Se 138th Dr, Portland, OR 97236 | 2014-04-09 |
| 1942623764 | Laurel Katherine Hallock Koppelman | Nurse Practitioner | 12720 Se Division Street, Portland, OR 97236 | 2014-01-30 |
| 1982046249 | Victoria D Lathrop | Massage Therapist | 17221 Se Divistion St S-21, Portland, OR 97236 | 2013-07-26 |
| 1669819694 | Ariann Von Vaughn | Dental Hygienist | 18011 Se Pershing Ct, Portland, OR 97236 | 2013-05-31 |
| Find all providers in zip 97236 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396259040 | Scott L. Barry, Dmd, PC | Dentist | 9020 Sw Washington Square Rd Ste 570, Portland, OR 97223-4477 | 2017-11-16 |
| 1386084564 | Sonja R Evans | Dentist | 82 Coyle St, Portland, ME 04101-1628 | 2013-07-02 |
| 1770849838 | West Coast Endodontics, PC | Dentist | 9907 Se Division Street, Ste A, Portland, OR 87266 | 2012-04-03 |
| 1780868687 | Dental Specialists of Portland | Dentist | 1355 Congress St, Suite A, Portland, ME 04102-2160 | 2007-12-27 |
| 1811197601 | Dental Specialists of Maine, LLC | Dentist | 1355 Congress St Ste A, Portland, ME 04102-2137 | 2007-07-20 |
| 1437365889 | Jason A Garlock | Dentist | 276 Canco Road, Granite Heights, Portland, ME 04103 | 2007-05-15 |
| 1346467404 | Tony Bassili | Dentist | 11982 Ne Glisan St, Portland, OR 97220-2143 | 2007-04-19 |
| 1427029503 | Brooks Bradley Horan | Dentist | 405 Se 133rd Ave, Portland, OR 97233-1809 | 2006-01-27 |
| 1497749881 | Scott W Edgar | Dentist | 1020 Ne 2nd Ave, #320, Portland, OR 97232-2064 | 2005-08-31 |
| 1053312595 | Danielle Paige Wingrove | Dentist | 2730 Sw Moody Ave # 5n032, Portland, OR 97201 | 2005-08-09 |
| Find all providers in PORTLAND | ||||
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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.