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2930 Ne Dekum St Portland OR 97211-6613 | |
| (800) 813-2000 | |
| (503) 286-6879 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2930 Ne Dekum St, Portland, Oregon |
| Authorized Official Name and Position | Amy Marko (DENTAL BUSINESS LEADER) |
| Authorized Official Contact | 5038134660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
500 Ne Multnomah St Portland OR 97232-2023 Ph: (800) 813-2000 | 2930 Ne Dekum St Portland OR 97211-6613 Ph: (800) 813-2000 |
| NPI Number | 1861918005 |
|---|---|
| Provider Enumeration Date | 08/18/2017 |
| Last Update Date | 06/01/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861918005 | NPI | - | NPPES |
| XXXXX | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 124Q00000X | Dental Hygienist | (* (Not Available)) | Secondary |
Kennedy Dental Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 3506 N Lombard St, Portland, OR 97217 Phone: 503-289-0230 Fax: 503-286-5055 | |
Hayden Family Dentistry Group Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 732 Sw 3rd Ave, Suite 202, Portland, OR 97204 Phone: 503-541-2580 | |
Master Dental Smiles Inc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 12661 Se Powell Blvd Ste C, Portland, OR 97236 Phone: 503-761-1900 | |
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