Provider Demographics
NPI:1164194775
Name:ORTHODONTIC SPECIALISTS OF LAKE OSWEGO
Entity Type:Organization
Organization Name:ORTHODONTIC SPECIALISTS OF LAKE OSWEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:503-635-9371
Mailing Address - Street 1:440 A AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3038
Mailing Address - Country:US
Mailing Address - Phone:503-635-9371
Mailing Address - Fax:
Practice Address - Street 1:440 A AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3038
Practice Address - Country:US
Practice Address - Phone:503-635-9371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty