Organization
MULTNOMAH COUNTY
Active
Parent organization
MULTNOMAH COUNTY
Other names
Northeast Dental Clinic
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
5329 NE MLK JR BLVD, PORTLAND, OR 97211-3237
(503) 988-3664
Mailing address
619 NW 6TH AVE, 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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