Dentist Providers In Lake Oswego, Oregon

Search Dentist NPI records in Lake Oswego, OR

Search or browse through the NPI records of dentist registered healthcare providers with a business address in Lake Oswego, OR. The listings include accepted insurance information, Medicare acceptance status, and PECOS enrollment data. The total number of NPI records is 93, of which 28 are registered as organizations and 65 as individuals. A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

70% Individuals

30% Organizations

18% Female

52% Male

70% Individual Providers (65)30% Medical Organizations (28)18% Female Providers (17)52% Male Providers (48)

Map of Providers

We have mapped the Dentist providers in Lake Oswego, OR to visually represent the practice location of each individual or organization. Click on any of the the pins to see the provider details at that location.

List of Providers

Table of Dentist NPI Profiles in Lake Oswego, OR
NPI	Name	Address	Insurance	Medicare	PECOS
1003010018	KARI BORGEN (Individual)	440 A AVE LAKE OSWEGO, OR 97034 (503) 635-9371	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1003015496	KENNETH BYRON WILTBANK (Individual)	320 A AVE LAKE OSWEGO, OR 97034 (503) 636-3383		Non-Participating Provider	YES
1003200205	RYAN RANDOL DDS PC (Organization)	3993 LAKE GROVE AVE LAKE OSWEGO, OR 97035 (503) 636-0055		Non-Participating Provider	NO
1013264308	NICHOLAS G DOSE (Individual)	601 1ST ST STE A LAKE OSWEGO, OR 97034 (503) 636-2525		Non-Participating Provider	YES
1013909274	SARAH MARGARET LEVISON (Individual)	9 MONROE PARKWAY SUITE 130 LAKE OSWEGO, OR 97035 (503) 699-1809	BridgeSpan Health Company PacificSource Health Plans Regence BlueCross BlueShield of Oregon	Non-Participating Provider	YES
1043424682	JESSICA ANNE VOGELSANG (Individual)	601 1ST ST LAKE OSWEGO, OR 97034 (503) 210-2310	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Dominion National Florida Combined Life Humana Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1053311977	PAUL L KIMBREL (Individual)	601 1ST ST LAKE OSWEGO, OR 97034 (503) 636-2525		Non-Participating Provider	NO
1073834073	CHRISTOPHER D KOONING (Individual)	15962 BOONES FERRY RD STE 105 LAKE OSWEGO, OR 97035 (503) 675-4594	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Delta Dental Plan of Oregon Dentegra Insurance Company Dominion National PacificSource Health Plans Paramount Paramount Dental Regence BlueCross BlueShield of Oregon	Non-Participating Provider	YES
1093708265	LARRY BOWDEN (Individual)	17720 JEAN WAY LAKE OSWEGO, OR 97035 (503) 675-7300		Non-Participating Provider	YES
1104173244	MAYERLE & TYDEMAN, LLC (Organization)	14800 KRUSE OAKS BLVD STE A LAKE OSWEGO, OR 97035 (503) 684-2944		Non-Participating Provider	NO
1104963537	BRADLEY E. SIEVERT (Individual)	16016 BOONES FERRY RD STE.100 LAKE OSWEGO, OR 97035 (503) 636-4576	Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Florida Combined Life Humana Regence BlueCross BlueShield of Oregon UnitedHealthcare	Opted out of Medicare	YES
1154874709	RACHEL E HOGAN (Individual)	5000 MEADOWS RD STE 230 LAKE OSWEGO, OR 97035 (503) 882-0026	BridgeSpan Health Company Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1164194775	ORTHODONTIC SPECIALISTS OF LAKE OSWEGO (Organization)	440 A AVE LAKE OSWEGO, OR 97034 (503) 635-9371		Non-Participating Provider	NO
1164605259	MATT JAMES HOIDAL (Individual)	300 OSWEGO POINTE DR STE 106 LAKE OSWEGO, OR 97034 (503) 635-3584		Non-Participating Provider	NO
1174997142	WIKLE DENTISTRY LLC WIKLE FAMILY DENTAL (Organization)	3900 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 636-8446		Non-Participating Provider	NO
1194823369	DISCHINGER ORTHODONTICS PC DISCHINGER TEAM (Organization)	3943 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 635-4439		Non-Participating Provider	NO
1205235405	DAVID MILLER (Individual)	671 COUNTRY CLUB RD LAKE OSWEGO, OR 97034 (503) 490-3272	BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National Humana PacificSource Health Plans	Non-Participating Provider	YES
1205514064	JOHN HOLT (Individual)	5 NORTHSHORE RD LAKE OSWEGO, OR 97034 (503) 610-1010	Ambetter from Arizona Complete Health Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BannerAetna BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Blue Cross Blue Shield of Arizona BridgeSpan Health Company Delta Dental of Arizona Delta Dental Plan of Oregon Florida Combined Life Humana Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental Solstice Healthplans of Arizona Inc. TRUASSURE INSURANCE COMPANY UnitedHealthcare	Non-Participating Provider	NO
1205821154	TIMOTHY JOHN EDVALSON (Individual)	3900 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 636-8446	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1205923513	LYNN E SMITH (Individual)	3975 MERCANTILE DR SUITE 167 LAKE OSWEGO, OR 97035 (503) 675-7333	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1235150459	HADI NOUREDINE (Individual)	9 MONROE PKWY STE C LAKE OSWEGO, OR 97035 (503) 635-3431	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental Plan of Oregon Dominion National Florida Combined Life Humana PacificSource Health Plans Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1245359868	JEFFREY AUSTIN WILLIAMSON (Individual)	5 CENTERPOINTE DR SUITE 260 LAKE OSWEGO, OR 97035 (503) 684-4174		Non-Participating Provider	NO
1245504950	LEVISON DENTAL GROUP PC (Organization)	9 MONROE PKWY SUITE 130 LAKE OSWEGO, OR 97035 (503) 699-1809		Non-Participating Provider	NO
1255339669	LYNN J STRAND (Individual)	320 A AVE LAKE OSWEGO, OR 97034 (503) 636-3383		Non-Participating Provider	YES
1255535175	DALE V RHONEY (Individual)	440 A AVE LAKE OSWEGO, OR 97034 (503) 635-9371		Non-Participating Provider	NO
1255791117	MATTHEW M SHEPPARD D.M.D L.L.C. (Organization)	15962 BOONES FERRY RD STE 208 LAKE OSWEGO, OR 97035 (503) 636-8154		Non-Participating Provider	NO
1265882484	CLAWSON & EBEL LLC THE DENTAL STUDIO (Organization)	510 4TH ST LAKE OSWEGO, OR 97034 (503) 636-4324		Non-Participating Provider	NO
1295015014	MO Y SALEH (Individual)	16455 BOONES FERRY RD LAKE OSWEGO, OR 97035 (503) 697-0884	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dental Health Services PacificSource Health Plans Paramount Paramount Dental	Non-Participating Provider	YES
1295404986	MARLO BULZA (Individual)	16679 BOONES FERRY RD STE 215 LAKE OSWEGO, OR 97035 (503) 636-7601	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National Paramount Paramount Dental	Non-Participating Provider	NO
1306860556	JACK ALBERT HENRY (Individual)	3993 LAKE GROVE AVE LAKE OSWEGO, OR 97035 (503) 636-0055	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1316292501	JESSICA COLLEEN RICE (Individual)	3975 MERCANTILE DR SUITE 150 LAKE OSWEGO, OR 97035 (503) 636-7601	BridgeSpan Health Company Regence BlueCross BlueShield of Oregon	Non-Participating Provider	YES
1336240993	DOUGLAS J. KLEIN (Individual)	601 1ST ST LAKE OSWEGO, OR 97034 (503) 636-8491		Non-Participating Provider	NO
1346453370	STEVEN BLAKLEY (Individual)	454 A AVE LAKE OSWEGO, OR 97034 (503) 636-3066	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Delta Dental Plan of Oregon Dentegra Insurance Company Dominion National Florida Combined Life Humana PacificSource Health Plans Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1356499586	LEILA TARSA (Individual)	320 'A' AVENUE LAKE OSWEGO, OR 97034 (503) 636-3383	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National PacificSource Health Plans Paramount Paramount Dental Renaissance Dental	Non-Participating Provider	NO
1356910947	SARA ANN EDMONDSON (Individual)	3943 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 389-0976		Non-Participating Provider	NO
1366157497	CASCADE ORAL AND FACIAL SURGERY, LLC CASCADE ORAL AND FACIAL SURGERY (Organization)	16455 BOONES FERRY RD STE B LAKE OSWEGO, OR 97035 (503) 482-7200		Non-Participating Provider	NO
1366793192	OREGON ENDODONTIC GROUP (Organization)	320 A AVE LAKE OSWEGO, OR 97034 (503) 636-3383		Non-Participating Provider	NO
1376971952	NICHOLAS G. DOSE, DMD, PC (Organization)	601 1ST ST STE A LAKE OSWEGO, OR 97034 (503) 636-2525		Non-Participating Provider	NO
1386861789	LIGIA INES MORRISON (Individual)	4200 SW MERCHANTILE DRIVE, SUITE 740 LAKE OSWEGO, OR 97035 (503) 699-7691	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National Guardian Humana PacificSource Health Plans Paramount Paramount Dental	Non-Participating Provider	NO
1386897841	LANCE ROSENAU (Individual)	4200 MERCANTILE DR SUITE 740 LAKE OSWEGO, OR 97035 (503) 699-7691		Non-Participating Provider	NO
1396905428	LISA SABIENNE SPINK (Individual)	454 A AVE LAKE OSWEGO, OR 97034 (503) 636-3066	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. PacificSource Health Plans Paramount Paramount Dental	Non-Participating Provider	NO
1396973681	MATTHEW ALLDREDGE STEVENS (Individual)	310 N STATE ST STE. 310 LAKE OSWEGO, OR 97034 (503) 636-9800	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Florida Combined Life Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1407897200	DR JEFFREY B VAN ORMAN (Organization)	320 A AVE LAKE OSWEGO, OR 97034 (503) 675-0250	UnitedHealthcare	Non-Participating Provider	NO
1407936107	WASHINGTON I KOHNKE (Individual)	601 FIRST ST LAKE OSWEGO, OR 97034 (503) 636-2300		Non-Participating Provider	NO
1427112804	JEFFREY DAVID SESSIONS (Individual)	310 N STATE ST STE 302 LAKE OSWEGO, OR 97034 (503) 636-5663	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1427297944	PATRICK MORRISSEY (Individual)	17437 BOONES FERRY RD BUILDING B, SUITE 400 LAKE OSWEGO, OR 97035 (503) 699-6699	BridgeSpan Health Company Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1427454925	WILLIAM MICHAEL DISCHINGER (Individual)	3943 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 635-4439	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1437362142	BILL RAYMOND SCHARWATT (Individual)	13980 AMBERWOOD CIRCLE LAKE OSWEGO, OR 97035 (503) 639-0974		Non-Participating Provider	NO
1457875700	PETERSON ORTHODONTICS & PERIODONTICS, LLC LAKE OSWEGO PERIODONTICS (Organization)	15962 BOONES FERRY RD STE 108 LAKE OSWEGO, OR 97035 (503) 699-6569		Non-Participating Provider	NO
1467668707	JON CHRISTOPHER ROBINSON (Individual)	310 N STATE ST SUITE 310 LAKE OSWEGO, OR 97034 (503) 636-9800	PacificSource Health Plans	Non-Participating Provider	NO
1487370193	OSLO ORTHO, LLC (Organization)	440 A AVE LAKE OSWEGO, OR 97034 (503) 635-9371	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1497971824	MICHAEL J CRISCIONE (Individual)	3975 MERCANTILE DR STE 150 LAKE OSWEGO, OR 97035 (503) 636-7601	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1528235314	GORDON L. WILTSHIRE, JR., DMD, PC LAKE GROVE DENTAL (Organization)	16455 BOONES FERRY RD STE A LAKE OSWEGO, OR 97035 (503) 636-3641		Non-Participating Provider	NO
1538267364	STACY A GEISLER (Individual)	16699 BOONES FERRY RD SUITE 100 LAKE OSWEGO, OR 97035 (503) 534-0114		Opted out of Medicare	YES
1538707294	LAKE OSWEGO MODERN DENTISTRY, PC LAKE OSWEGO MODERN DENTISTRY (Organization)	4823 MEADOWS RD STE 131 LAKE OSWEGO, OR 97035 (503) 334-0351	Delta Dental Plan of Oregon UnitedHealthcare	Non-Participating Provider	NO
1558570622	MATTHEW DONOVAN GOODHUE (Individual)	17050 PILKINGTON RD. SUITE 230 LAKE OSWEGO, OR 97035 (503) 636-6644	BridgeSpan Health Company PacificSource Health Plans Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1568476406	PAUL PETER ORTNER (Individual)	16679 BOONES FERRY RD STE 205 LAKE OSWEGO, OR 97035 (503) 635-2100		Non-Participating Provider	NO
1609869577	RYAN J HUGHES (Individual)	8 N STATE ST SUITE 203 LAKE OSWEGO, OR 97034 (503) 635-3483	BridgeSpan Health Company Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1629095526	ROBERT H. WOOLF, DDS, PC (Organization)	320 A AVE LAKE OSWEGO, OR 97034 (503) 635-3584		Non-Participating Provider	NO
1639178478	CHARLES L BRANEN (Individual)	16455 BOONES FERRY RD STE A LAKE OSWEGO, OR 97035 (503) 636-3641	BridgeSpan Health Company Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1639346778	COLIN L SMITH (Individual)	16699 BOONES FERRY RD STE 200 LAKE OSWEGO, OR 97035 (503) 635-3653		Non-Participating Provider	YES
1649293663	OSWEGO DENTAL ASSOCIATES LAKE OSWEGO DENTAL CENTER (Organization)	9 MONROE PKWY STE C LAKE OSWEGO, OR 97035 (503) 635-3431	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1669484648	JOHN D HANNA (Individual)	8 N STATE ST SUITE 203 LAKE OSWEGO, OR 97034 (503) 635-3483		Non-Participating Provider	NO
1689830556	IAN STUART TYDEMAN (Individual)	14800 KRUSE OAKS BLVD SUITE A LAKE OSWEGO, OR 97035 (503) 684-2944		Non-Participating Provider	NO
1730171992	SCOTT LEVISON (Individual)	9 MONROE PKWY SUITE 130 LAKE OSWEGO, OR 97035 (503) 699-1809	BridgeSpan Health Company PacificSource Health Plans Regence BlueCross BlueShield of Oregon	Non-Participating Provider	YES
1750998852	CANDID OREGON, LLC (Organization)	5200 MEADOWS RD STE 200 LAKE OSWEGO, OR 97035 (860) 481-7631		Non-Participating Provider	NO
1760430912	PATRICK W MORRISSEY DDS LLC BOONES FERRY DENTAL (Organization)	17437 SW BOONES FERRY ROAD BUILDING B SUITE 400 LAKE OSWEGO, OR 97035 (503) 699-6699		Non-Participating Provider	NO
1770382814	DISCHINGER AND ENSLEY ORTHODONTIC GROUP TWO LLC (Organization)	3943 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 635-4439		Non-Participating Provider	NO
1770826224	PETER DENNIS (Individual)	16455 BOONES FERRY RD STE B LAKE OSWEGO, OR 97035 (503) 482-7200	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Dominion National Humana Moda Health Plan Inc. PacificSource Health Plans Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental	Accepts Medicare	YES
1780728832	MANAMI YAMAGUCHI (Individual)	15074 BANGY RD LAKE OSWEGO, OR 97035 (503) 635-3306		Non-Participating Provider	YES
1780763151	JOSEPH RICHARD LEBEN (Individual)	691 7TH ST LAKE OSWEGO, OR 97034 (503) 635-9784		Non-Participating Provider	NO
1811008170	DAVID ROBERT BURTON (Individual)	4035 MERCANTILE DR SUITE 100 LAKE OSWEGO, OR 97035 (503) 635-9979		Non-Participating Provider	NO
1811164155	CRISCIONE FAMILY DENTISTRY, PC (Organization)	3975 MERCANTILE DR #150 LAKE OSWEGO, OR 97035 (503) 636-7601	Delta Dental Plan of Oregon	Non-Participating Provider	NO
1821164427	MAYERLE DENTAL (Organization)	14800 KRUSE OAKS DR STE A LAKE OSWEGO, OR 97035 (503) 684-2944		Non-Participating Provider	NO
1821462821	SYED HUSAIN ASGHAR (Individual)	4823 MEADOWS RD STE 131 LAKE OSWEGO, OR 97035 (503) 334-0351		Non-Participating Provider	YES
1831319474	THE ART OF SMILEMAKING (Organization)	4200 SW MERCANTILE DR STE 740 LAKE OSWEGO, OR 97035 (503) 699-7691		Non-Participating Provider	NO
1831882893	JEE YOUNG HAN (Individual)	5 CENTERPOINTE DR STE 260 LAKE OSWEGO, OR 97035 (503) 684-4174	Delta Dental Plan of Oregon Florida Combined Life Humana UnitedHealthcare	Non-Participating Provider	NO
1841844354	CARLY CHRISTOFERSON PETERSEN (Individual)	3900 DOUGLAS WAY LAKE OSWEGO, OR 97035 (503) 636-8446	Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Delta Dental Plan of Oregon Dominion National Florida Combined Life Regence BlueCross BlueShield of Oregon Renaissance Dental	Non-Participating Provider	NO
1851393714	JOHN BENJAMIN HOLT (Individual)	5 N SHORE RD LAKE OSWEGO, OR 97034 (503) 635-3438	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Delta Dental Plan of Oregon	Non-Participating Provider	NO
1851694640	BRAD A MAYERLE (Individual)	14800 KRUSE OAKS BLVD LAKE OSWEGO, OR 97035 (503) 684-2944		Non-Participating Provider	NO
1861177917	RUNAZ BARZANGY (Individual)	4823 MEADOWS RD STE 131 LAKE OSWEGO, OR 97035 (503) 334-0351	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National Humana Paramount Paramount Dental Renaissance Dental UnitedHealthcare	Non-Participating Provider	YES
1871613463	DAN EVERETT THOMPSON (Individual)	17704 JEAN WAY SUITE 105 LAKE OSWEGO, OR 97035 (503) 675-6776	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Renaissance Dental	Non-Participating Provider	NO
1871755587	JOHN LINDSAY TULLIS (Individual)	16463 BOONES FERRY RD STE 200 THE OLSON MEMORIAL CLINIC LAKE OSWEGO, OR 97035 (503) 635-7701	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas	Non-Participating Provider	NO
1881256766	WALIED ELDOMIATY (Individual)	4055 MERCANTILE DR APT 374 LAKE OSWEGO, OR 97035 (202) 285-8313	Anthem Blue Cross and Blue Shield Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Delta Dental Plan of Oregon Dentegra Insurance Company Dominion National Florida Combined Life Humana Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1881731990	DENTAL DYNAMICS P. C. (Organization)	16455 BOONES FERRY RD LAKE OSWEGO, OR 97035 (503) 697-0884	UnitedHealthcare	Non-Participating Provider	NO
1891903951	OFP LLC (Organization)	691 7TH ST LAKE OSWEGO, OR 97034 (503) 635-9784		Non-Participating Provider	NO
1902803984	JEFFREY B VANORMAN (Individual)	320 A AVE LAKE OSWEGO, OR 97034 (503) 675-0250	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Alabama Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Dentegra Insurance Company Florida Combined Life Humana Paramount Paramount Dental Regence BlueCross BlueShield of Oregon UnitedHealthcare	Non-Participating Provider	YES
1912313610	MAYERLE DENTAL PC (Organization)	14800 KRUSE OAKS BLVD LAKE OSWEGO, OR 97035 (503) 684-2944		Non-Participating Provider	NO
1932192630	DOUGLAS A. RUST (Individual)	3970 MERCANTILE DR STE 140 LAKE OSWEGO, OR 97035 (503) 626-6800	BridgeSpan Health Company Delta Dental Plan of Oregon PacificSource Health Plans Regence BlueCross BlueShield of Oregon	Non-Participating Provider	NO
1932233483	SUE E WENDLING (Individual)	17437 SW BOONES FERRY RD SUITE 400 LAKE OSWEGO, OR 97035 (503) 636-4069	Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas Dominion National Florida Combined Life PacificSource Health Plans Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1942432786	JULIA V SAVINA (Individual)	200 GREENRIDGE DR #209 LAKE OSWEGO, OR 97035 (925) 788-6696	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Delta Dental Plan of Oregon Dentegra Insurance Company Dominion National Florida Combined Life Humana PacificSource Health Plans Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental UnitedHealthcare	Non-Participating Provider	NO
1952577058	LAKE OSWEGO SMILES (Organization)	16699 BOONES FERRY RD STE 200 LAKE OSWEGO, OR 97035 (503) 635-3653		Non-Participating Provider	NO
1952736555	BRENDEN BELL (Individual)	15962 BOONES FERRY RD STE 105 LAKE OSWEGO, OR 97035 (509) 540-9369	Antidote Health Plan of Arizona Inc. Antidote Health Plan of Ohio Inc. BEST Life Blue Cross and Blue Shield of Illinois Blue Cross and Blue Shield of Montana Blue Cross and Blue Shield of Oklahoma Blue Cross and Blue Shield of Texas BridgeSpan Health Company Dominion National Humana PacificSource Health Plans Paramount Paramount Dental Regence BlueCross BlueShield of Oregon Renaissance Dental	Non-Participating Provider	YES

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