Mountainside Family Dentistry Llc is a Dental Clinic in Portland, Oregon. It is located at 3740 Se 122nd Ave, Portland, OR and its contact number is 503-762-2525. The authorized person for Mountainside Family Dentistry Llc is Dr. Derek W. Conklin
who is Dentist/owner/ President of the clinic and their contact number is 503-762-2525. Other organizations associated with this clinic are Mountainside General Dentistry, Anthony M El Youssef Dmd Pc, Mountainside Family Dentistry Llc, The primary license number for Mountainside Family Dentistry Llc is D8325 (Dentist) in Oregon.
Mountainside Family Dentistry Llc Clinic have dental surgeons who are specialized in dentistry, diagnosis, prevention, and treatment of diseases and conditions of the oral cavity. The dentist's supporting team aids in providing oral health services. The dental team includes dental assistants, dental hygienists, dental technicians, and sometimes dental therapists.
Complete Clinic Profile:
Mountainside Family Dentistry Llc Clinic speciality, address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointments.
| Name: | Mountainside Family Dentistry Llc |
| Specialization: | Dentistry |
| Clinic Address: | 3740 Se 122nd Ave, Portland,
Oregon, 97236-3405 |
| Phone: | 503-762-2525 |
| Fax: | 503-762-4872 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints for this clinic are as below. Person's position and contact details are also mentioned below.
| Name: | Dr. Derek W. Conklin |
| Position: | Dentist/owner/ President |
| Contact Number: | 503-762-2525 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details for Mountainside Family Dentistry Llc clinic are as mentioned below.
| NPI Number: | 1295080836 |
| NPI Enumeration Date: | 19 Jul, 2012 |
| NPI Last Update On: | 19 Jul, 2012 |
Other Associated Organizations:
Other organizations which are associated with this clinic are as mentioned below. These organization share the same address but have similar or different specialization.
Speciality of these organizations are also mentioned below.
| Name | Specialization | NPI Number |
| Mountainside General Dentistry | Dentistry | 1215104476 |
| Anthony M El Youssef Dmd Pc | Dentistry | 1215598263 |
| Mountainside Family Dentistry Llc | Dentistry | 1295080836 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mountainside Family Dentistry Llc are as mentioned below.
| Specialization | License Number | State | Status | |
| Dentist | D8325 | Oregon | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers of the clinic such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 243185 | Medicaid | Oregon | |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | Mountainside Family Dentistry Llc
3740 Se 122nd Ave,
Portland, Oregon |
| Zip: | 97236-3405 |
| Phone Number: | 503-762-2525 |
| Fax Number: | 503-762-4872 |
Patients can reach Mountainside Family Dentistry Llc at
3740 Se 122nd Ave, Portland, Oregon or can
call to book an appointment on 503-762-2525.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.