Organization
MULNOMAH COUNTY
Active
Other names
MC Reynolds Dental
Organization subpart
No
Provider details
NPI number
Authorized official
DERRICK MOTEN (INTERIM BUSINESS SERVICES DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
1698 SW CHERRY PARK RD, TROUTDALE, OR 97060-1481
(503) 988-3340
Mailing address
619 SW 6TH AVE., 5TH FL, PORTLAND, OR 97209
(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
—
22959
—
OR
Enumeration date
12/10/2021
Last updated
05/18/2024
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