Provider Demographics
NPI:1639138613
Name:KAIP, MARK JAMES (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:JAMES
Last Name:KAIP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SW FIRST AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201
Mailing Address - Country:US
Mailing Address - Phone:503-222-6611
Mailing Address - Fax:503-296-5460
Practice Address - Street 1:2000 SW FIRST AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201
Practice Address - Country:US
Practice Address - Phone:503-222-6611
Practice Address - Fax:503-296-5460
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009094122300000X
OR07987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist