Provider Demographics
NPI:1831550326
Name:DENTAL3
Entity type:Organization
Organization Name:DENTAL3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:KIRCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-810-6525
Mailing Address - Street 1:7420 SW HUNZIKER ST STE F
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8242
Mailing Address - Country:US
Mailing Address - Phone:503-521-7166
Mailing Address - Fax:
Practice Address - Street 1:7420 SW HUNZIKER ST STE F
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8242
Practice Address - Country:US
Practice Address - Phone:503-521-7166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization