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

Providence Health & Services - Oregon

Organization Oral & Maxillofacial Surgery (D.M.D.) · NPI 1407109937

Providence Health & Services - Oregon is an Oral & Maxillofacial Surgery (D.M.D.) in Portland, Oregon. Registered with an NPI since 2012.

In the registry since
2012
Specialties on file
2

Practice location Address checks out

4805 NE Glisan St Ste 11N
Portland, OR 97213-2933
Phone: (503) 215-3053
Fax: (503) 215-3037
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral & Maxillofacial Surgery (D.M.D.) (primary) Taxonomy 204E00000X
Clinic/Center Taxonomy 261Q00000X

Record details

NPI number1407109937
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Donald Anderson — Assistant Secretary Enrollment · (425) 358-9786
Other names Providence Medical Group; Providence Oral Head And Neck Clinic
NPI enumeratedOctober 22, 2012
Last updated in NPPESMarch 23, 2026
Certification dateMarch 23, 2026
Mailing addressPo Box 31001 - 4180, Pasadena, CA 91110-4180

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