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Active NPI 1184362329 Organization (Entity Type 2)

Gresham Dg Llc

Clinic/Center - Dental • Gresham, OR

About Gresham Dg Llc NPI 1184362329 Summary

Gresham Dg Llc is a verified healthcare organization specializing in Clinic/Center - Dental operating in Gresham, OR. Located at 455 WEST POWELL BLVD, this facility provides patient care and medical services under National Provider Identifier (NPI) 1184362329.

Administrative operations and authorized compliance are overseen by Ryan Smith (Manager).

Facility Location & Contact Primary Location

Facility Address

455 West Powell Blvd

Gresham, OR 97030

Telephone 5036619696

Authorized Official Information

Authorized Contact Name

Ryan Smith , DDS

Title / Role

Manager

Official Telephone

9717089540

Facility Classifications & Specialties

Clinic/Center - Dental Primary Taxonomy

NUCC Taxonomy Code: 261QD0000X

Definition to come...

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events

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NPI Profile Active May 26, 2022

NPI status registered as active in NPPES database

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Updated Practice Location May 26, 2022

Registered at 455 WEST POWELL BLVD, GRESHAM, OR 97030 (Tel: 5036619696)

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Updated Business Mailing Address May 26, 2022

Registered at 455 WEST POWELL BLVD, GRESHAM, OR 97030

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Organization / Clinic Name Updated May 26, 2022

Operating as GRESHAM DG LLC

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Medical Taxonomy / Specialty Registered (Primary Specialty) May 26, 2022

Clinic/Center

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Initial NPI Registration & Enumeration May 26, 2022

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

Verified patient ratings, healthcare experiences, and facility photos

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NPI Organization Metadata

NPI Number: 1184362329

Entity Type:

Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)

Enumeration Date: May 26, 2022

Last Update: May 26, 2022

Update or Correct Listing

Mailing Address

455 West Powell Blvd

Gresham, OR 97030

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.

⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.