| Mid County Dental Clinic | |
|
12710 Se Division St Portland OR 97236-3134 | |
| (503) 988-3410 | |
| Not Available |
| Full Name | Mid County Dental Clinic |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 12710 Se Division St, Portland, Oregon |
| Authorized Official Name and Position | Derrick Moten (INTERIM BUSINESS SERVICES DIRECTOR) |
| Authorized Official Contact | 5039882966 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mid County Dental Clinic 619 Nw 6th Ave Ste 500 Portland OR 97209-3964 Ph: (503) 988-7468 | Mid County Dental Clinic 12710 Se Division St Portland OR 97236-3134 Ph: (503) 988-3410 |
| NPI Number | 1083115612 |
|---|---|
| Provider Enumeration Date | 02/28/2018 |
| Last Update Date | 05/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083115612 | NPI | - | NPPES |
| 022959 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Oregon) | Secondary |
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (Oregon) | Primary |
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 | |
Northeast Family Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1904 Ne 45th Ave, Portland, OR 97213 Phone: 503-281-0866 Fax: 503-281-0867 | |
Sundberg Center For Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 222 Nw 10th Ave, Portland, OR 97209 Phone: 503-546-9079 Fax: 503-546-5474 | |
Solutions For Smiles Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1238 Se 122nd Ave, Portland, OR 97233 Phone: 503-255-6815 Fax: 503-255-3044 | |
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 | |
Glenna K. Sequeira Dmd, Pc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 2440 Ne Fremont St, Portland, OR 97212 Phone: 503-249-8771 Fax: 503-249-8772 |