Organization
MULTNOMAH COUNTY
Active
Parent organization
MULTNOMAH COUNTY
Other names
MC Fernhill Dental
Organization subpart
Yes
Provider details
NPI number
Legal business name
MULTNOMAH COUNTY
Authorized official
DERRICK MOTEN (DEPUTY DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
5530 NE 42ND AVE, PORTLAND, OR 97218-1408
(503) 988-3129
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3991
(503) 988-7468
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
Enumeration date
01/22/2025
Last updated
01/22/2025
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