| NPI | 1336640960 |
|---|---|
| Doing Business As | NORTHEAST DENTAL CLINIC |
| Entity Type | Organization |
| Authorized Contact | DERRICK MOTEN Interim Business Services Director 503-988-2966 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2024-05-18 |