NORTHEAST DENTAL CLINIC – NPI #1336640960
Clinic/Center

NORTHEAST DENTAL CLINIC is an AHC clinic located in PORTLAND, OR. NPPES has assigned the NPI number 1336640960 to NORTHEAST DENTAL CLINIC on February 28, 2018. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “NORTHEAST DENTAL CLINIC” is a dba name, the actual legal business name for this organization is MULTNOMAH COUNTY. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 2 years ago on May 18, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for NORTHEAST DENTAL CLINIC below.

NPI Profile for
MULTNOMAH COUNTY

NPI Number
1336640960
Enumeration Date

(more than 8 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
MULTNOMAH COUNTY
Doing Business As (dba): NORTHEAST DENTAL CLINIC
Primary location
5329 NE MLK JR BLVD
PORTLAND, OR 97211-3237
Phone: (503) 988-3664 Fax:
Mailing address
619 NW 6TH AVE
PORTLAND, OR 97209-3964
Phone: (503) 988-7468 Fax:
Organization Subpart
Yes - NORTHEAST DENTAL CLINIC is subpart of another organization.
Authorized Official
DERRICK MOTEN
INTERIM BUSINESS SERVICES DIRECTOR
Phone: (503) 988-2966
Updated
Certification Date
May 18, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for NORTHEAST DENTAL CLINIC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
medicaidOR022959
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
OR
261QD0000X
- Clinic/Center / Dental
OR

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.