Provider Demographics
NPI:1881082097
Name:ZOOMCARE DENTAL, P.C.
Entity type:Organization
Organization Name:ZOOMCARE DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-684-8252
Mailing Address - Street 1:19075 NW TANASBOURNE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5860
Mailing Address - Country:US
Mailing Address - Phone:503-684-8252
Mailing Address - Fax:866-859-8195
Practice Address - Street 1:3130 SE DIVISION STREET
Practice Address - Street 2:BUILDING 2
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202
Practice Address - Country:US
Practice Address - Phone:503-684-8252
Practice Address - Fax:866-859-8195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD100371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty