Provider Demographics
NPI:1487801528
Name:THE DENTAL FOUNDATION OF OREGON
Entity type:Organization
Organization Name:THE DENTAL FOUNDATION OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TOOTH TAXI PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-329-8877
Mailing Address - Street 1:PO BOX 2448
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-2448
Mailing Address - Country:US
Mailing Address - Phone:503-594-0880
Mailing Address - Fax:503-218-2448
Practice Address - Street 1:10505 SE 17TH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7475
Practice Address - Country:US
Practice Address - Phone:503-329-8877
Practice Address - Fax:503-218-2004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty