Organization
BILLI ODEGAARD DENTAL CLINIC
Active
Parent organization
MULTNOMAH COUNTY
Organization subpart
Yes
Provider details
NPI number
Legal business name
MULTNOMAH COUNTY
Authorized official
DERRICK MOTEN (INTERIM BUSINESS SERVICES DIRECTOR)
(503) 988-2966
Entity
Organization
Contact information
Practice address
33 NW BROADWAY, STE 380, PORTLAND, OR 97209-3580
(503) 988-5770
(503) 988-5442
Mailing address
619 NW 6TH AVE STE 500, PORTLAND, OR 97209-3964
(503) 988-7468
(503) 988-3015
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
022959
—
OR
05
—
096511
—
OR
Enumeration date
09/14/2012
Last updated
05/18/2024
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