Provider Demographics
NPI:1609006568
Name:OREGON HEALTH AND SCIENCE UNIVERSITY
Entity Type:Organization
Organization Name:OREGON HEALTH AND SCIENCE UNIVERSITY
Other - Org Name:DCH PEDIATRIC DENTAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-494-8801
Mailing Address - Street 1:611 SW CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3001
Mailing Address - Country:US
Mailing Address - Phone:503-418-5799
Mailing Address - Fax:
Practice Address - Street 1:700 SW CAMPUS DRIVE
Practice Address - Street 2:MAIL CODE - DC8S
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-418-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty