PEDIATRIC DENTAL CLINIC (NPI# 1679897292) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679897292 |
| Entity Type | Organization |
| Organization Name | PEDIATRIC DENTAL CLINIC |
| Practice Address |
19255 Sw 65th Ave Suite 250 Tualatin OR 97062-7451 |
| Practice Telephone | 5036121897 |
| Practice Fax Number | 5036121899 |
| Mailing Telephone | 5036121897 |
| Mailing Fax Number | 5036121899 |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2010-03-25 |
| Authorized Official Name | DR. BEN BUM-JOON KANG (OWNER) |
| Authorized Official Telephone | 5036121897 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861996035 | Pediatric Dental Clinic | Dentist | 162 Ana Dr, Florence, AL 35630-1759 | 2018-03-21 |
| Street Address |
19255 SW 65TH AVE SUITE 250 |
| City | TUALATIN |
| State | OR |
| Zip Code | 97062-7451 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912906405 | Michael R Vanallen | Specialist | 19255 Sw 65th Ave, Suite 210, Tualatin, OR 97062-7451 | 2005-07-18 |
| 1306208897 | Thomas P. Mcweeney Md PC | Specialist | 19255 Sw 65th Ave, Suite 110, Tualatin, OR 97062-7451 | 2016-03-23 |
| 1003295775 | Proactive Physical Therapy Tualatin | Physical Therapist | 19255 Sw 65th Ave, Suite 250, Tualatin, OR 97062-7451 | 2015-05-27 |
| 1376972182 | Oregon Spine Care LLC | Orthopaedic Surgery | 19255 Sw 65th Ave, Suite 200, Tualatin, OR 97062-7451 | 2013-11-02 |
| 1215243316 | Heather Wehling Peterson | Occupational Therapist | 19255 Sw 65th Ave, Suite 210, Tualatin, OR 97062-7451 | 2010-08-26 |
| 1386964401 | Michael Craig Collison | Physical Therapist | 19255 Sw 65th Ave, Ste. 120, Tualatin, OR 97062-7451 | 2010-06-11 |
| 1285863092 | Kevin Applin Hanson | Physical Therapist | 19255 Sw 65th Ave, Suite 120, Tualatin, OR 97062-7451 | 2009-07-14 |
| 1427285436 | Matthew Stephen Rogers | Physical Therapist | 19255 Sw 65th Ave, Suite 120, Tualatin, OR 97062-7451 | 2009-06-17 |
| 1790937662 | Michael R Van Allen Md PC | Physical Medicine & Rehabilitation | 19255 Sw 65th Ave, Suite 210, Tualatin, OR 97062-7451 | 2008-10-22 |
| 1144478553 | Drew Thomas Herion | Dentist | 19255 Sw 65th Ave, Suite 230, Tualatin, OR 97062-7451 | 2008-08-28 |
| Find all providers in the same location | ||||
| 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 | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265430821 | Patricia L Ridgley | Dentist | 18803 Sw Boones Ferry Rd, Ste 5, Tualatin, OR 97062-8412 | 2005-07-08 |
| 1922045574 | Ben Bum-joon Kang | Dentist | 19255 Sw 65th Ave, Suite 250, Tualatin, OR 97062-7451 | 2006-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588297279 | Dennis M Dunne Dds PC | Dentist | 1600 Executive Pkwy Ste 350, Eugene, OR 97401-7110 | 2020-02-20 |
| 1225678139 | Eric E Jacobsen Dds PC | Dentist | 19502 Molalla Ave Ste 109, Oregon City, OR 97045-4513 | 2020-01-08 |
| 1982168506 | Anthony Frank Vinciguerra | Dentist | 37315 Second St, Nehalem, OR 97131-9679 | 2019-01-28 |
| 1114493582 | Matt W Anderson Dds PC | Dentist | 2215 Willamette St Ste A, Eugene, OR 97405-3341 | 2018-10-23 |
| 1366923245 | Big Tooth Little Tooth Pediatric Dentistry PC | Dentist | 2020 8th Ave Ste 121, West Linn, OR 97068-4657 | 2018-08-28 |
| 1578057618 | Bittner & Flann LLC | Dentist | 17680 Sw Handley St Ste 201, Sherwood, OR 97140-9299 | 2018-06-21 |
| 1700374154 | Fox Kids Dentistry & Orthodontics II | Dentist | 1401 Se Morrison St Ste 120, Portland, OR 97214-2777 | 2018-05-01 |
| 1053812081 | Armin Afshar | Dentist | 201 Se Washington St Ste A, Dallas, OR 97338-2860 | 2018-02-25 |
| 1942712922 | Harmony Pediatric Dental Group LLC | Dentist | 37515 Se Hwy 26, Sandy, OR 97055 | 2017-10-30 |
| 1790225399 | Childrens Dentistry | Dentist | 515 W Idaho Ave, Ontario, OR 97914-2348 | 2017-03-01 |
| 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.