OrganizationActive
Mountainside Family Dentistry LLC
NPI 1295080836 · Dentist · Portland, OR
Mountainside Family Dentistry LLC is a Dentist organization in Portland, OR (NPI 1295080836).
Provider details
- NPI number
- 1295080836
- Entity type
- Organization
- Primary specialty
- DentistDental Providers
- Organization subpart
- No
- Authorized official
- Derek Conklin, Dentist/Owner/ President(503) 762-2525
- License
- D8325 (OR)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(79/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
13 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
3740 Se 122nd Ave
Portland, OR 97236-3405
Phone: (503) 762-2525
Fax: (503) 762-4872
Street-level locationGet directions
Mailing address
3740 Se 122nd Ave
Portland, OR 97236-3405
Registry dates
- Enumerated
- 2012-07-19
- Last updated
- 2012-07-19
Frequently asked questions
- What is Mountainside Family Dentistry LLC's NPI number?
- Mountainside Family Dentistry LLC's National Provider Identifier (NPI) is 1295080836, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Mountainside Family Dentistry LLC?
- Mountainside Family Dentistry LLC is classified in the NPPES registry as Dentist (Dental Providers).
- Where is Mountainside Family Dentistry LLC located?
- Mountainside Family Dentistry LLC's practice location on file with NPPES is 3740 Se 122nd Ave, Portland, OR 97236-3405.
- What is Mountainside Family Dentistry LLC's phone number?
- The practice phone number listed in the NPPES registry for Mountainside Family Dentistry LLC is (503) 762-2525.
- Who is the authorized official for Mountainside Family Dentistry LLC?
- The authorized official listed on Mountainside Family Dentistry LLC's NPPES record is Derek Conklin, Dentist/Owner/ President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Mountainside Family Dentistry LLC's NPI active?
- Yes — Mountainside Family Dentistry LLC's NPI (1295080836) is active in the NPPES registry as of the last update on 2012-07-19.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.