Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mountainside Family Dentistry LLC

Organization Dentist · NPI 1295080836

Mountainside Family Dentistry LLC is a Dentist in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2012.

Licensed in
OR
In the registry since
2012
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3740 SE 122nd Ave
Portland, OR 97236-3405
Phone: (503) 762-2525
Fax: (503) 762-4872
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D8325 (OR)

Record details

NPI number1295080836
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Derek Conklin — Dentist/Owner/ President · (503) 762-2525
NPI enumeratedJuly 19, 2012
Last updated in NPPESJuly 19, 2012
Mailing address3740 Se 122nd Ave, Portland, OR 97236-3405

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