Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jantzen Beach Modern Dentistry, PC

Organization General Practice Dentistry · NPI 1558792051

Jantzen Beach Modern Dentistry, PC provides General Practice Dentistry in Portland, Oregon. Registered with an NPI since 2013.

In the registry since
2013
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

12239 N Center Ave
Portland, OR 97217-7806 Not confirmed with CMS for 12 years — call before visiting
Phone: (503) 241-1800
Fax: (503) 241-1807
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X

Record details

NPI number1558792051
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Todd Cockrell — Owner · (503) 241-1800
Other names Jantzen Beach Modern Dentistry
NPI enumeratedDecember 9, 2013
Last updated in NPPESDecember 9, 2013
Mailing address17000 Red Hill Ave, Irvine, CA 92614-5626

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