NPI 1407109937

Providence Health & Services - Oregon

Organisation Oral & Maxillofacial Surgery (D.M.D.) Portland, OR

Practice location

Address: 4805 NE Glisan St STE 11n, Portland, OR 97213-2933
Phone: (503) 215-3053
Fax: (503) 215-3037
Mailing address: PO Box 31001 - 4180, Pasadena, CA 91110-4180

Authorised official

Name: Donald Wayne Anderson
Title: Assistant Secretary Enrollment
Phone: (425) 358-9786

Registered specialties (2)

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X

Other Oral & Maxillofacial Surgery providers in Oregon →

Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261Q00000X

Other Clinic/Center providers in Oregon →

Registry record

NPI: 1407109937
Entity type: Organization
NPI issued: 22 Oct 2012
Record last updated: 23 Mar 2026

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.