Organization
MULTNOMAH COUNTY
Active
Parent organization
MULNOMAH COUNTY
Other names
Mid County Dental Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
MULNOMAH COUNTY
Authorized official
DERRICK MOTEN (INTERIM BUSINESS SERVICES DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3410
Mailing address
619 NW 6TH AVE STE 500, PORTLAND, OR 97209-3964
(503) 988-7468
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
OR
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
02/28/2018
Last updated
05/18/2024
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