Provider Demographics
NPI:1730432295
Name:PACIFIC UNIVERSITY DENTAL HEALTH CLINIC
Entity type:Organization
Organization Name:PACIFIC UNIVERSITY DENTAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-352-2663
Mailing Address - Street 1:222 SE 8TH AVE
Mailing Address - Street 2:#271
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4218
Mailing Address - Country:US
Mailing Address - Phone:503-352-7373
Mailing Address - Fax:503-352-7260
Practice Address - Street 1:222 SE 8TH AVE
Practice Address - Street 2:#271
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-352-7373
Practice Address - Fax:503-352-7260
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PACIFIC UNIVERSITY OREGON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-22
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty