Provider Demographics
NPI:1871197624
Name:DISTINCTIVE DENTISTRY, LLC
Entity Type:Organization
Organization Name:DISTINCTIVE DENTISTRY, LLC
Other - Org Name:DISTINCTIVE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KLEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-701-3589
Mailing Address - Street 1:13110 SE SUNNYSIDE RD STE A
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-8468
Mailing Address - Country:US
Mailing Address - Phone:036-984-8845
Mailing Address - Fax:503-698-6601
Practice Address - Street 1:13110 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97015-8468
Practice Address - Country:US
Practice Address - Phone:503-698-4884
Practice Address - Fax:503-698-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental