Provider Demographics
NPI:1689183717
Name:KAI-UWE H. HAHN DMD DBA EDELWEISS DENTAL
Entity Type:Organization
Organization Name:KAI-UWE H. HAHN DMD DBA EDELWEISS DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KAI-UWE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-283-1198
Mailing Address - Street 1:3503 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5901
Mailing Address - Country:US
Mailing Address - Phone:503-283-1198
Mailing Address - Fax:503-283-3262
Practice Address - Street 1:3503 N LOMBARD STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-283-1198
Practice Address - Fax:503-283-3262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1590927-9
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9530261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental