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MID COUNTY DENTAL CLINIC
NPI 1083115612
Clinic/Center - Federally Qualified Health Center (FQHC) in Portland, OR

Active since February 28, 2018
12710 SE DIVISION ST, PORTLAND, OR 97236(503) 988-3410 Get Directions Write a Review

NPPES record last updated: May 18, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 18, 2024, Mar 16, 2019, Feb 28, 2018 (3 updates tracked since 2018).

About Mid County Dental Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MID COUNTY DENTAL CLINIC (NPI 1083115612) is a healthcare organization registered as a federally qualified health center (fqhc) in Portland, Oregon and active in the NPI registry since February 2018. The organization lists Derrick Moten, Interim Business Services Director, as its authorized official.

NPPES Registry Identity

NPI1083115612
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameMULTNOMAH COUNTY
Location Address12710 SE DIVISION STPortland, OR 97236-3134
Mailing Address619 Nw 6th Ave Ste 500Portland, OR 97209-3964 · (503) 988-7468
Phone(503) 988-3410
Organization SubpartYesParent: Mulnomah County
Authorized OfficialDerrick MotenInterim Business Services Director · (503) 988-2966
Enumeration DateFebruary 28, 2018
Last NPPES UpdateMay 18, 20243 updates tracked since enumeration
NPPES CertifiedMay 18, 2024
✔ NPI 1083115612 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · DentalTaxonomy 261QD0000X
12710 SE DIVISION ST, Portland, OR 97236
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Other Names 1

Doing Business AsMid County Dental Clinic

Other Identifiers 1

Medicaid022959OR

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SERGEY Y KIRPICHENKO DMD
Dentist (General Practice)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
DR. SAMY F TANYOS D.M.D.
Dentist
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3816
DONALD EUGENE POSTEN LCSW
Social Worker (Clinical)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3601
DR. ALYSSA T FRANZEN DMD
Dentist (General Practice)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
DERRICK MICHAEL JONES PA-C
Physician Assistant (Medical)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3601
WHITNEY THOMAS
Nurse Practitioner (Family)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-5558
DR. MASTANEH POURNADERI D.D.S
Dentist
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410
DR. DANIEL E SKOURTES D.M.D
Dentist (General Practice)
12710 SE DIVISION ST
PORTLAND, OR 97236
Multnomah County (503) 988-3410

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Multnomah County's NPI number?

The NPI number for Multnomah County is 1083115612. It was assigned to this organization in the NPPES registry on February 28, 2018. The provider is doing business as Mid County Dental Clinic.

Where is Multnomah County located?

Multnomah County is located at 12710 SE Division St, Portland, OR 97236. The listed phone number is (503) 988-3410.

What is Multnomah County's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

When was this NPI record last updated?

The NPPES record for Multnomah County was last updated on May 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.