Provider Demographics
NPI:1336691625
Name:KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST
Other - Org Name:OREGON CITY DENTAL OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VP DENTAL CARE SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-813-4660
Mailing Address - Street 1:500 NE MULTNOMAH ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2023
Mailing Address - Country:US
Mailing Address - Phone:800-813-2000
Mailing Address - Fax:503-286-6879
Practice Address - Street 1:1900 MCLOUGHLIN BLVD
Practice Address - Street 2:SUITE 69
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1067
Practice Address - Country:US
Practice Address - Phone:800-813-2000
Practice Address - Fax:503-286-6879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER PERMANENTE DENTAL CARE PROGRAM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-02
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty