Organization · Type 2 NPI

Providence Health & Services - Oregon

Oral & Maxillofacial Surgery (D.M.D.) · Portland, OR

NPI number 1407109937 Active

Practice location

4805 NE Glisan St Ste 11N
Portland, OR 97213-2933

Call (503) 215-3053 Map

Fax (503) 215-3037

Mailing address

PO Box 31001 - 4180
Pasadena, CA 91110-4180

Specialties and licenses

Taxonomy	Code	License
Oral & Maxillofacial Surgery (D.M.D.) Primary	204E00000X	None listed
Clinic/Center	261Q00000X	None listed

Oral & Maxillofacial Surgery (D.M.D.): 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 j…

38 other providers at this address

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NPI record

NPI: 1407109937
Entity type: Organization (Type 2)
Issued: Oct 22, 2012
Last updated: Mar 23, 2026
Status: Active

Other names

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Providence Medical Group · doing business as
Providence Oral Head and Neck Clinic · doing business as

Authorized official

Donald Wayne Anderson
Assistant Secretary Enrollment
(425) 358-9786

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1407109937

Providence Health & Services - Oregon's National Provider Identifier is 1407109937, issued on Oct 22, 2012. The primary taxonomy on file is Oral & Maxillofacial Surgery (D.M.D.) (204E00000X), and the practice location is in Portland, OR. The record was last updated on Mar 23, 2026.