PROVIDENCE HEALTH & SERVICES - OREGON
NPI 1407109937
Oral & Maxillofacial Surgery in Portland, OR

Q: What is Providence Health & Services - Oregon's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Active since October 22, 2012

4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213(503) 215-3053(503) 215-3037 Get Directions Write a Review

NPPES record last updated: March 23, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 23, 2026, Jul 4, 2025, May 16, 2025 (3 updates tracked since 2025).

On this page

About Providence Health & Services - Oregon NPPES

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

PROVIDENCE HEALTH & SERVICES - OREGON (NPI 1407109937), doing business as Providence Medical Group, is a healthcare organization registered as an oral & maxillofacial surgery in Portland, Oregon and active in the NPI registry since October 2012. The organization lists Donald Wayne Anderson, Assistant Secretary Enrollment, as its authorized official.

NPPES Registry Identity

NPI1407109937

Entity TypeOrganization

Primary Taxonomy204E00000X

Legal Business NamePROVIDENCE HEALTH & SERVICES - OREGON

Location Address4805 NE GLISAN ST STE 11NPortland, OR 97213-2933

Mailing AddressPo Box 31001 - 4180Pasadena, CA 91110-4180

Phone(503) 215-3053

Fax(503) 215-3037

Organization SubpartNo

Authorized OfficialDonald Wayne AndersonAssistant Secretary Enrollment · (425) 358-9786

Enumeration DateOctober 22, 2012

Last NPPES UpdateMarch 23, 20263 updates tracked since enumeration

NPPES CertifiedMarch 23, 2026

✔ NPI 1407109937 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code204E00000X

Definition

Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.

Also ListedClinic/CenterTaxonomy 261Q00000X

4805 NE GLISAN ST STE 11N, Portland, OR 97213

Open in Google Maps ↗

Other Names 2

Doing Business AsProvidence Medical Group

Doing Business AsProvidence Oral Head And Neck Clinic

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medical Equipment Supplier Medicare DMEPOS 3

Medicare supplier enrollment and the product categories Providence Transitions carries, from the Medicare DMEPOS supplier directory.

Providence Transitions

DMEPOS supplier · Portland, OROperated by Providence Health & Services Oregon

✔

Accepts Medicare assignment

Providence Transitions agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20483441

Medicare Participant SinceMay 11, 2015

Supplier Location4805 NE Glisan St 1st Floor Cancer CenterPortland, OR 97213

Phone(503) 215-8998

Supplier Specialties

Medical Supply Company Other

Medicare Product Categories

Breast Prostheses and/or Accessories

Prosthetic bra, Surgical bra

Surgical Dressings

Gauze, Elastic bandages, Adhesive tape

Lymphedema Compression Treatment Items

Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Leave this field empty

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.

PROVIDENCE HEALTH & SERVICES - OREGON

Obstetrics & Gynecology