Organization
EXCEPTIONAL NEEDS DENTAL SERVICES (ENDS)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TONIA AYRES (ADMINISTRATOR)
(503) 295-1201
Entity
Organization
Contact information
Practice address
12029 NE SUMNER ST, PORTLAND, OR 97220-9015
(503) 295-1201
(503) 295-1211
Mailing address
12029 NE SUMNER ST, PORTLAND, OR 97220-9015
(503) 295-1201
(503) 295-1211
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
821498
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086020
—
OR
Enumeration date
12/19/2006
Last updated
02/22/2013
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