Provider Demographics
NPI:1194002725
Name:ORAL HEALTH OUTREACH, LLC
Entity Type:Organization
Organization Name:ORAL HEALTH OUTREACH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:MARKUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-702-1113
Mailing Address - Street 1:4949 MEADOWS RD
Mailing Address - Street 2:SUITE 475
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-4285
Mailing Address - Country:US
Mailing Address - Phone:503-702-1113
Mailing Address - Fax:503-697-1990
Practice Address - Street 1:4949 MEADOWS RD
Practice Address - Street 2:SUITE 475
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-4285
Practice Address - Country:US
Practice Address - Phone:503-702-1113
Practice Address - Fax:503-697-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7025261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental