ROOTS DENTAL BROADWAY LLC – NPI #1568977817
Clinic/Center

ROOTS DENTAL BROADWAY LLC is an AHC clinic located in PORTLAND, OR. NPPES has assigned the NPI number 1568977817 to ROOTS DENTAL BROADWAY LLC on December 08, 2017. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The former legal business name for this organization is NE DENTAL ASSOCIATES. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for ROOTS DENTAL BROADWAY LLC below.

NPI Profile for
ROOTS DENTAL BROADWAY LLC

NPI Number
1568977817
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
ROOTS DENTAL BROADWAY LLC
Former Legal Business Name: NE DENTAL ASSOCIATES
Primary location
2525 NE BROADWAY ST STE 200
PORTLAND, OR 97232-3527
Phone: (503) 234-7870 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
RYAN SMITH
MANAGER
Phone: (503) 234-7870
Updated
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)		 OR D10629

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.