Organization
OREGON HEALTH & SCIENCE UNIVERSITY
Active
Other names
OHSU Faculty Dental Practice
Organization subpart
No
Provider details
NPI number
Authorized official
MEGAN A SAGE (DIRECTOR PT SPPT SRVS OPERATIONS)
(503) 494-5076
Entity
Organization
Contact information
Practice address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
(503) 494-4316
(503) 494-2365
Mailing address
2730 S MOODY AVE, PORTLAND, OR 97201-5042
(503) 494-4316
(503) 494-2365
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0300X
Periodontics
—
—
1223P0700X
Prosthodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
1223X2210X
Orofacial Pain Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500750380
—
OR
Enumeration date
11/02/2006
Last updated
03/21/2023
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