Mr. Matthew Edward Bourg is a Portland, Oregon based Dentist who is specialized in
Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Mr. Matthew Edward Bourg is
D6261 for Dentistry in Oregon. His current practice location is
17236 Se Stark St, Portland. Patients can reach him at
503-254-1260.
Mr. Matthew Edward Bourg is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Mr. Matthew Edward Bourg speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Mr. Matthew Edward Bourg |
| Specialization: | Dentist |
| Gender: | Male |
| Credentials: | DMD |
| Accepts Medicare Assignment: | No |
| Practice Address: | 17236 Se Stark St, Portland,
Oregon, 97233-4546 |
| Phone: | 503-254-1260 |
| Fax: | 503-254-1494 |
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 are as mentioned below.
| NPI Number: | 1902994312 |
| NPI Enumeration Date: | 11 Oct, 2006 |
| NPI Last Update On: | 08 Jul, 2007 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mr. Matthew Edward Bourg are as mentioned below.
| License Number | Specialization | State | Status | |
| D6261 | Dentistry | Oregon | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Mr. Matthew Edward Bourg such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 117721 | Medicaid | Oregon | |
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 17236 Se Stark St,
Portland, Oregon |
| Zip: | 97233-4546 |
| Phone Number: | 503-254-1260 |
| Fax Number: | 503-254-1494 |
Patients can reach Mr. Matthew Edward Bourg at
17236 Se Stark St, Portland, Oregon or can
call to book an appointment on 503-254-1260.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
09 March, 2026.