PERIODONTAL ASSOCIATES, LLC (NPI# 1669710331) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669710331 |
| Entity Type | Organization |
| Organization Name | PERIODONTAL ASSOCIATES, LLC |
| Practice Address |
18753 Sw Martinazzi Ave Tualatin OR 97062-6808 |
| Practice Telephone | 5036202807 |
| Practice Fax Number | 5039685419 |
| Mailing Telephone | 5036202807 |
| Mailing Fax Number | 5036202807 |
| Enumeration Date | 2013-01-30 |
| Last Update Date | 2015-08-24 |
| Authorized Official Name | BRADLEY MCALLISTER (PARTNER) |
| Authorized Official Telephone | 5036202807 |
| Authorized Official Credential | DDS, PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
D6900 | OR | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558364091 | Periodontal Associates, LLC | Dentist | 61 4th St, Stamford, CT 06905-5010 | 2005-05-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PERIODONTAL ASSOCIATES, LLC | 18753 Sw Martinazzi Ave, Tualatin, OR 97062 |
| Street Address |
18753 SW MARTINAZZI AVE |
| City | TUALATIN |
| State | OR |
| Zip Code | 97062-6808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346317948 | Vahid Thomas Eshraghi | Dentist | 18753 Sw Martinazzi Ave, Tualatin, OR 97062-6808 | 2006-11-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467018739 | Activeedge Tualatin, LLP | Physical Therapist | 19150 Sw 90th Avenue, Suite 200, West Linn, OR 97062 | 2019-05-13 |
| 1932607934 | Naturalways Pediatrics | Clinic/Center | 18813 Sw Martiazzi Ave, Tualatin, OR 97062 | 2018-01-25 |
| 1831646280 | Elizabeth Erin Tafesse | Behavioral Analyst | 18765 Sw Boones Ferry Rd Suite 100, Tualatin, OR 97062 | 2016-09-01 |
| 1962851311 | Ana Mercedes Cerritos-sanchez | Community Health Worker | 19355 Sw 65th Ave Apt A5, Tualatin, OR 97062 | 2016-06-07 |
| 1952759318 | William Luke Summers | Counselor | 18840 Southwest Boones Ferry Rd, Suite 208, Tualatin, OR 97062 | 2016-05-26 |
| 1730536913 | Krystle Alligood | Behavioral Analyst | 18768 Sw Boones Ferry Road, Tualatin, OR 97062 | 2016-05-18 |
| 1760869739 | Oregon City Medical Nw, Inc | Clinic/Center | 6464 Sw Borland Road #d-4, Tualatin, OR 97062 | 2015-04-29 |
| 1396148904 | Tracy Filley | Clinical Nurse Specialist | 18840 Sw Boones Ferry Rd, Suite 208, Tualatin, OR 97062 | 2014-09-28 |
| 1043646474 | Michelle Lords | Registered Nurse | 7668 Sw Mohawk Street, Tualatin, OR 97062 | 2013-09-17 |
| 1871930750 | Sharon Ruth Frank | Social Worker | 7668 Sw Mohawk St., Aps Healthcare, Tualatin, OR 97062 | 2013-05-31 |
| Find all providers in zip 97062 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346317948 | Vahid Thomas Eshraghi | Dentist | 18753 Sw Martinazzi Ave, Tualatin, OR 97062-6808 | 2006-11-29 |
| 1952550048 | Erwin Weichel Dmd Ms PC | Dentist | 18761 Sw Martinazzi Ave, Tualatin, OR 97062-6808 | 2008-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871026062 | Leila Soltani | Dentist | 430 Sw 13th Ave Apt 2010, Portland, OR 97205 | 2017-04-05 |
| 1427504828 | Shashank Joshi | Dentist | 1739 W Harvard Ave, Roseburg, OR 97471-2716 | 2016-08-26 |
| 1982056479 | Mari Heslinga | Dentist | 21332 Sw Langer Farms Pkwy Ste 126, Sherwood, OR 97140 | 2016-07-07 |
| 1376944314 | Mikhail Garibov | Dentist | 17895 Nw Evergreen Pkwy Ste 130, Beaverton, OR 97006-7402 | 2014-09-09 |
| 1548671340 | Polaris Dental Specialists | Dentist | 620 12th Street Se, Salem, OR 97301 | 2014-05-14 |
| 1295159986 | Andrew N Dow Dmd PC | Dentist | 4750 Village Plaza Loop Ste 102, Eugene, OR 97401-6601 | 2014-02-14 |
| 1043581465 | Riverplace Periodontics PC | Dentist | 2636 Se Harrison Street, Suite A, Milwaukie, OR 97222 | 2012-01-17 |
| 1730472986 | Wilson D Lee | Dentist | 315 Nw Lost Springs Ter, #401, Portland, OR 97229-6444 | 2011-05-20 |
| 1184954422 | Kamran Haghighat Bds Ms PC | Dentist | 833 Sw 11th Ave Ste 1020, Portland, OR 97205-2124 | 2010-01-08 |
| 1467683276 | Sunny L Drake | Dentist | 2235 Mission St Se Ste 250, Salem, OR 97302-1294 | 2009-07-29 |
| 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.