| Multnomah County Donald E Long Dental | |
|
1401 Ne 68th Ave Portland OR 97213-4957 | |
| (503) 988-5033 | |
| Not Available |
| Full Name | Multnomah County Donald E Long Dental |
|---|---|
| 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 |
|---|---|
| Multnomah County Donald E Long Dental 619 Nw 6th Ave Fl 5 Portland OR 97209-3964 Ph: (503) 988-7468 | Multnomah County Donald E Long Dental 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 |
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