Organization
MULNOMAH COUNTY
Active
Parent organization
MULNOMAH COUNTY
Other names
Multnomah County School Oral Health
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
3505 SE 182ND AVE, GRESHAM, OR 97030-5028
(503) 988-5488
(503) 988-5484
Mailing address
421 SW OAK ST STE 210, PORTLAND, OR 97204-1842
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
06/14/2018
Last updated
05/18/2024
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