# KRISTA V BADGER DDS PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376646901
- **Authorized official:** KRISTA VON HUSEN BADGER DDS (OWNER)
- **Authorized official phone:** (503) 288-5891

## Contact information

- **Practice address:** 3839 NE TILLAMOOK ST, PORTLAND, OR 97212-5338
- **Practice address phone:** (503) 288-5891
- **Practice address fax:** (503) 288-1525
- **Mailing address:** 3839 NE TILLAMOOK ST, PORTLAND, OR 97212-5338
- **Mailing address phone:** (503) 288-5891
- **Mailing address fax:** (503) 288-1525

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | D7649 | OR | Yes |

## Other

- **Enumeration date:** 09/07/2006
- **Last updated:** 08/13/2009