Provider Demographics
NPI:1619188711
Name:HARRISON DENTAL, LLC
Entity Type:Organization
Organization Name:HARRISON DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MARK KAIP, D.D. S., P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAIP
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-222-6611
Mailing Address - Street 1:1800 S.W. 1RST AVE.
Mailing Address - Street 2:SUITE 530
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5328
Mailing Address - Country:US
Mailing Address - Phone:503-222-6611
Mailing Address - Fax:503-222-0560
Practice Address - Street 1:1800 S.W. 1RST AVE.
Practice Address - Street 2:SUITE 530
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-5328
Practice Address - Country:US
Practice Address - Phone:503-222-6611
Practice Address - Fax:503-222-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR49611223G0001X
OR79871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1639138613OtherTYPE 1
OR1679534606OtherTYPE 1