Kaiser Foundation Health Plan Of The Northwest
Dentist, General Practice in Portland, OR. Organization (NPI-2).
NPI number1982156113
StatusActive
Last updated in NPPESJun 1, 2021
Details
- NPI
- 1982156113
- Entity type
- Organization (NPI-2)
- Legal business name
- Kaiser Foundation Health Plan Of The Northwest
- Organization subpart
- Yes
- Enumeration date
- Nov 4, 2016
- Certification date
- Jun 1, 2021
- Last updated
- Jun 1, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | – | – | Yes |
Other names
- Grand Avenue Dental Office (Other Name)
Practice location
1314 Ne Grand AvePortland, OR 97232-1127
Phone 800-813-2000 · Fax 503-286-6879
Mailing address
500 Ne Multnomah StPortland, OR 97232-2023
Phone 800-813-2000 · Fax 503-286-6879
Authorized official
Kenneth R Wright
Vp Dental Care Services
5038134660
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