Healthcare Provider Details

I. General information

NPI: 1861305344
Provider Name (Legal Business Name): NEON ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4838 NE SANDY BLVD STE 101
PORTLAND OR
97213-2090
US

IV. Provider business mailing address

4838 NE SANDY BLVD STE 101
PORTLAND OR
97213-2090
US

V. Phone/Fax

Practice location:
  • Phone: 503-287-9710
  • Fax:
Mailing address:
  • Phone: 503-287-9710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER CROWE
Title or Position: OWNER
Credential: DDS,MS
Phone: 503-287-9710