Healthcare Provider Details

I. General information

NPI: 1821857293
Provider Name (Legal Business Name): ELLEN KRIPPAEHNE CIOBANASIU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELLEN KRIPPAEHNE

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 SW 11TH AVE STE 300
PORTLAND OR
97205-2117
US

IV. Provider business mailing address

833 SW 11TH AVE STE 300
PORTLAND OR
97205-2117
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 503-222-0029
Mailing address:
  • Phone: 503-220-8262
  • Fax: 503-222-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12105
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: