Healthcare Provider Details

I. General information

NPI: 1093097958
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MCLOUGHLIN BLVD STE 68
OREGON CITY OR
97045-1072
US

IV. Provider business mailing address

1900 MCLOUGHLIN BLVD STE 68
OREGON CITY OR
97045-1072
US

V. Phone/Fax

Practice location:
  • Phone: 503-387-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number126800000X
License Number StateOR

VIII. Authorized Official

Name: GRANT COLBY
Title or Position: DENTAL OFFICE MANAGER
Credential:
Phone: 503-387-8000