Organization
MULNOMAH COUNTY
Active
Parent organization
MULTNOMAH COUNTY
Other names
Multnomah County Donald E Long Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MULTNOMAH COUNTY
Authorized official
DERRICK MOTEN (INTERIM BUSINESS SERVICES DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
1401 NE 68TH AVE, PORTLAND, OR 97213-4957
(503) 988-5033
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
(503) 988-7468
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
09/15/2021
Last updated
05/18/2024
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