Provider Demographics
NPI:1679388136
Name:EAST CITY DENTAL
Entity type:Organization
Organization Name:EAST CITY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAKOTA
Authorized Official - Middle Name:
Authorized Official - Last Name:H.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-253-0291
Mailing Address - Street 1:15925 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-3525
Mailing Address - Country:US
Mailing Address - Phone:503-253-0291
Mailing Address - Fax:503-253-1096
Practice Address - Street 1:15925 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-3525
Practice Address - Country:US
Practice Address - Phone:503-253-0291
Practice Address - Fax:503-253-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty