Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mountainside Family Dentistry LLC

Organization Dentist · NPI 1295080836

Mountainside Family Dentistry LLC provides Dentist services in Portland, Oregon. Licensed in Oregon. Registered with an NPI since 2012.

Licensed in
OR
In the registry since
2012
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3740 SE 122nd Ave
Portland, OR 97236-3405 Not confirmed with CMS for 14 years — call before visiting
Phone: (503) 762-2525
Fax: (503) 762-4872
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence D8325 (OR)

Record details

NPI number1295080836
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Derek Conklin — Dentist/Owner/ President · (503) 762-2525
NPI enumeratedJuly 19, 2012
Last updated in NPPESJuly 19, 2012
Mailing address3740 Se 122nd Ave, Portland, OR 97236-3405

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