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MOUNTAINSIDE FAMILY DENTISTRY LLC
NPI 1295080836
Dentist in Portland, OR

Active since July 19, 2012
3740 SE 122ND AVE, PORTLAND, OR 97236(503) 762-2525(503) 762-4872 Get Directions Write a Review

NPPES record last updated: July 19, 2012. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mountainside Family Dentistry Llc NPPES

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

MOUNTAINSIDE FAMILY DENTISTRY LLC (NPI 1295080836) is a healthcare organization registered as a dentist in Portland, Oregon and active in the NPI registry since July 2012. The organization lists Derek W. Conklin, Dentist/owner/ President, as its authorized official.

NPPES Registry Identity

NPI1295080836
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NameMOUNTAINSIDE FAMILY DENTISTRY LLC
Location Address3740 SE 122ND AVEPortland, OR 97236-3405
Mailing Address3740 Se 122nd AvePortland, OR 97236-3405 · (503) 762-2525 · Fax (503) 762-4872
Phone(503) 762-2525
Fax(503) 762-4872
Organization SubpartNo
Authorized OfficialDerek W. ConklinDentist/owner/ President · (503) 762-2525
Enumeration DateJuly 19, 2012
✔ NPI 1295080836 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in OR · D8325
Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

3740 SE 122ND AVE, Portland, OR 97236
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Other Identifiers 1

Medicaid243185OR

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

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

MOUNTAINSIDE GENERAL DENTISTRY
Dentist
3740 SE 122ND AVE
PORTLAND, OR 97236
Multnomah County (503) 762-2525
ANTHONY M EL YOUSSEF DMD PC
Dentist
3740 SE 122ND AVE
PORTLAND, OR 97236
Multnomah County (503) 762-2525
LENORE SUPNET D.M.D.
Dentist (General Practice)
3740 SE 122ND AVE
PORTLAND, OR 97236
Multnomah County (503) 762-2525

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 Mountainside Family Dentistry LLC's NPI number?

The NPI number for Mountainside Family Dentistry LLC is 1295080836. It was assigned to this organization in the NPPES registry on July 19, 2012.

Where is Mountainside Family Dentistry LLC located?

Mountainside Family Dentistry LLC is located at 3740 SE 122nd Ave, Portland, OR 97236. The listed phone number is (503) 762-2525.

What is Mountainside Family Dentistry LLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Mountainside Family Dentistry LLC was last updated on July 19, 2012. NPI Profile syncs with the weekly NPPES data releases published by CMS.