Provider Demographics
NPI:1427594118
Name:PORTLAND EMERGENCY DENTAL CARE USA PC
Entity Type:Organization
Organization Name:PORTLAND EMERGENCY DENTAL CARE USA PC
Other - Org Name:EMERGENCY DENTAL CARE USA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OBENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-393-2726
Mailing Address - Street 1:4245 S 143RD CIR
Mailing Address - Street 2:STE. 7
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-4516
Mailing Address - Country:US
Mailing Address - Phone:402-393-2726
Mailing Address - Fax:
Practice Address - Street 1:8401 NE HALSEY ST
Practice Address - Street 2:STE 12
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5670
Practice Address - Country:US
Practice Address - Phone:503-234-9911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty