Healthcare Provider Details

I. General information

NPI: 1972466100
Provider Name (Legal Business Name): RITTA KARAM DMD MA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19059 SE DIVISION ST
GRESHAM OR
97030-5165
US

IV. Provider business mailing address

19059 SE DIVISION ST
GRESHAM OR
97030-5165
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-4711
  • Fax: 503-661-4711
Mailing address:
  • Phone: 503-661-4711
  • Fax: 503-661-4711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RITTA KARAM
Title or Position: DENTIST
Credential: MA, DMD
Phone: 503-661-4711