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Organization

KAISER PERMANENTE DENTAL CARE PROGRAM

Active
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Organization

KAISER PERMANENTE DENTAL CARE PROGRAM

Active
Parent organization
KAISER FOUNDATION HEALTH PLAN OF THE NW
Other names
Kaiser Permanente 3 to PhD Dental
Organization subpart
Yes

Provider details

NPI number
Legal business name
KAISER FOUNDATION HEALTH PLAN OF THE NW
Authorized official
MRS. AMY MARKO (DENTAL BUSINESS LEADER)
(503) 813-4660
Entity
Organization

Contact information

Practice address
2930 NE DEKUM ST, PORTLAND, OR 97211-6613
(800) 813-2000
(503) 286-6879
Mailing address
500 NE MULTNOMAH ST, PORTLAND, OR 97232-2023
(800) 813-2000
(503) 286-6879

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
124Q00000X
Dental Hygienist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
XXXXX
OR
Enumeration date
08/18/2017
Last updated
06/01/2021
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