Provider Demographics
NPI:1942304662
Name:KAISER PERMANENTE DENTAL CARE
Entity Type:Organization
Organization Name:KAISER PERMANENTE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIO DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCCOMMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:503-653-7411
Mailing Address - Street 1:16167 SE RIVER FOREST PL
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-3614
Mailing Address - Country:US
Mailing Address - Phone:503-653-7411
Mailing Address - Fax:
Practice Address - Street 1:2300 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1223
Practice Address - Country:US
Practice Address - Phone:503-370-4843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH1918124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty