OrganizationActive
Laurissa Champion DMD LLC
NPI 1063774784 · Periodontics · Portland, OR
Provider details
- NPI number
- 1063774784
- Entity type
- Organization
- Primary specialty
- PeriodonticsDental Providers
- Organization subpart
- No
- Authorized official
- Laurissa Champion, Owner(503) 954-1372
- License
- D8555 (OR)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
2824 Ne Wasco St
Suite 230
Portland, OR 97232-1772
Phone: (503) 954-1372
Fax: (503) 954-1392
Street-level locationGet directions
Mailing address
2824 Ne Wasco St
Portland, OR 97232-1772
Other names (DBA / former)
- Other name
- Eastside Periodontics & Implantology
Registry dates
- Enumerated
- 2012-06-08
- Last updated
- 2012-06-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.