Organization
MULTNOMAH COUNTY
Active
Parent organization
MULNOMAH COUNTY
Other names
Multnomah County Inverness Dental
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
11540 NE INVERNESS DR., INVERNESS JAIL, PORTLAND, OR 97220
(503) 988-5033
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
(503) 988-7468
(503) 988-3015
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
07/09/2019
Last updated
05/18/2024
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