NPI 1073676037

Exceptional Needs Dental Services (ends)

Organisation Health Maintenance Organization Portland, OR

Practice location

Address: 12029 NE Sumner St, Portland, OR 97220-9015
Phone: (503) 295-1201
Fax: (503) 295-1211

Authorised official

Name: Tonia Ayres
Title: Administrator
Phone: (503) 295-1201

Registered specialties

Health Maintenance Organization Primary

Managed Care Organizations Taxonomy 302R00000X Licence 821498 (OR)

Other Health Maintenance Organization providers in Oregon →

Registry record

NPI: 1073676037
Entity type: Organization
NPI issued: 19 Dec 2006
Record last updated: 22 Feb 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.