Healthcare Provider Details

I. General information

NPI: 1295526002
Provider Name (Legal Business Name): MAI DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 SW NIMBUS AVE
BEAVERTON OR
97008-7150
US

IV. Provider business mailing address

9975 SW NIMBUS AVE
BEAVERTON OR
97008-7150
US

V. Phone/Fax

Practice location:
  • Phone: 714-204-8508
  • Fax:
Mailing address:
  • Phone: 971-246-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CHLOE ADAMS
Title or Position: PEDIATRIC DENTIST (OWNER)
Credential: DMD
Phone: 714-204-8508