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1401 Ne 68th Ave Portland OR 97213-4957 | |
| (503) 988-5033 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1401 Ne 68th Ave, 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 |
|---|---|
619 Nw 6th Ave Fl 5 Portland OR 97209-3964 Ph: (503) 988-7468 | 1401 Ne 68th Ave Portland OR 97213-4957 Ph: (503) 988-5033 |
| NPI Number | 1083384747 |
|---|---|
| Provider Enumeration Date | 09/15/2021 |
| Last Update Date | 05/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083384747 | NPI | - | NPPES |
| 022959 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | 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 | |
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 |