OrganizationActive
Providence Health & Services - Oregon
NPI 1407109937 · Oral & Maxillofacial Surgery (D.M.D.) · Portland, OR
Provider details
- NPI number
- 1407109937
- Entity type
- Organization
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)Allopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Donald Anderson, Assistant Secretary Enrollment(425) 358-9786
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Clinic/Center261Q00000X
Ambulatory Health Care Facilities
Practice location
4805 Ne Glisan St Ste 11n
Portland, OR 97213-2933
Phone: (503) 215-3053
Fax: (503) 215-3037
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 31001 - 4180
Pasadena, CA 91110-4180
Other names (DBA / former)
- Doing business as
- Providence Medical Group
- Doing business as
- Providence Oral Head and Neck Clinic
Registry dates
- Enumerated
- 2012-10-22
- Last updated
- 2026-03-23
- Certified
- 2026-03-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.