DENTAL PROVIDER DIRECTORY

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DENTAL PROVIDER DIRECTORY

THIS DIRECTORY APPLIES TO THE FOLLOWING NETWORKS: CLASSIC, CLASSIC COMPLETE, CLASSIC + DENTAL CHOICE, ADDED CHOICE + DENTAL CHOICE, DENTAL, DENTAL CHOICE

KAISER PERMANENTE NORTHWEST REGION

P U B L I S H E D S E P T E M B E R

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Listed providers are affiliated with Permanente Dental Associates. The information in this directory is updated monthly. For the most up-to-date information, please visit kp.org or contact Member Services at 1-800-813- 2000. The availability of physicians, hospitals, providers, and services may change.

Information about practitioners is provided to us by the practitioners or is obtained as part of the credentialing process and is accurate as of the date on the directory.

If you have questions, please call Member Services from 8 a.m. to 6 p.m., Monday through Friday, at 1-800-813-2000. For TTY, call 711. For language interpretation services, call 1-800-324-8010.

Help in your language

Interpreter services, including American Sign Language (ASL), are available during business hours at no additional cost to members. Many of our doctors also speak more than one language. Call 1-800-324-8010 (toll free), or 1-800-813-2000 (toll free) or 711 (TTY).

You can also call the Oregon Board of

Dentistry at 971-673-3200 or the Washington State Department of Health at 360-236-4700 for more information, including malpractice history and disciplinary actions.

Dental Choice PPO members

If you are on a Dental Choice PPO plan, some of the information in this directory may not apply to you. Dental choice PPO plans have some requirements and restrictions that are different from our other dental plans. Please read your

Evidence of Coverage to fully understand how

your plan works. This directory does not include all of the providers for your plan. For a complete listing visit kp.org/dental/nw to search our online directory or call 1-866-498-7912.

Accessibility of dental offices in this directory

All Kaiser Permanente facilities are accessible to members.

To report provider directory inaccuracies, please call Member Services at 1-800-813-2000 or go to kp.org/webmanager.

Community Referrals

Affiliated community dentists are not part of Permanente Dental Associates (PDA). They are dentists credentialed by PDA for Kaiser Foundation Health Plan of the Northwest, and they have a contract with PDA. If your PDA dentist decides that you require covered services not available internally from a PDA dentist, he or she may refer you to an affiliated community dentist. You must have a written, authorized referral from PDA in order to receive a covered service from an affiliated community dentist.

COVID-19 Update: To help ensure the safety of our members, staff, and community, we may need to temporarily close or limit in-person services at some of our medical and dental facilities. You can still get the care you need, including in- person emergency care, e-visits, phone or video visits, and more.

For the most up to date information please visit kp.org/coronavirus.

All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest.

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For members enrolled through the Federal Employees Health Benefits (FEHB) program

It is important to know that when you enroll in this Plan, services are provided through the Plan’s delivery system as described in the Plan’s Evidence of Coverage, but the continued participation of any one doctor, hospital, or other provider cannot be guaranteed.

All providers listed in this directory speak English.

Abbreviations of dental professional titles

DDS Doctor of Dental Surgery DMD Doctor of Medical Dentistry

We have dental professionals practicing in the following specialties:

Denturist

A dental technician who specializes in making and fitting dentures.

Endodontist

A dentist who specializes in root canals and the treatment of diseases or injuries that affect the pulp of teeth.

Orthodontist

A dentist who specializes in preventing and treating misaligned teeth.

Pediatric dentist

A dentist who specializes in treating children from birth through adolescence.

Periodontist

A specialist who treats the gums and supporting structures of the teeth.

Prosthodontist

A dentist who specializes in restoring teeth and/or replacing missing teeth with bridges, dentures, crowns, or implants.

Dental Providers, Kaiser Permanente, Northwest Region.

Providers accepting new members indicated in the Accepting New Members column.

Last updated September 2021. For the most up-to-date information, visit kp.org.

19416_09-21

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Aloha Dental Office

17675 SW Tualatin Valley Highway Beaverton, OR. 97003

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Members Specialty Board Certification Hospital Affiliations

Referral Required

Languages other than English

Charles G Row, DDS M Y General Dentist N

David K Walker, DMD M Y General Dentist N

Jay Wylam, DMD M Y Periodontist American Board of

Periodontology (ABoP) N

Lindsey Gaulke Popov, DMD F Y General Dentist N

Nipoon V. Dave, DDS M Y General Dentist N

Patrick Heaphy, DMD M Y Endodontist N

Beaverton Dental Office 4855 SW Western Avenue Beaverton, OR. 97005 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Deepak Devarajan, DMD M Y General Dentist N

Justin Elson, DMD M Y General Dentist N

Russel G Leoni, DMD M Y General Dentist N

Tommy Ngo, DMD M Y General Dentist N

Wendy L Kincaid Smovir, DMD F Y General Dentist N

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Cascade Park Dental Office 12711 SE Mill Plain Blvd Vancouver, WA. 98684 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Aaron S Johnson, DMD M Y General Dentist N

David A Straube, DMD M Y General Dentist N

Elizabeth Takamori, DDS F Y Endodontist American Board of

Endodontics (ABoE) N

Elly Kim, DDS F Y General Dentist N

Emily Passino, DMD F Y General Dentist N

Jennifer Egli, DDS, MS F Y Orthodontist N

Johanna L White, DDS F Y General Dentist N

Linh T Vo-Cheng, DMD F Y Pediatric Dentist Kaiser Interstate ASC N

Nikolas E Rawley, DMD M Y General Dentist N

Richard Omans, DDS M Y General Dentist N

Cedar Hills Dental Office 12450 SW Walker Rd Beaverton, OR. 97005 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Andrea Fraser, DDS F Y General Dentist N

Cyrus Jeh Lee, DMD M Y General Dentist N

Daniel J Pihlstrom, DDS M Y General Dentist N

Paula Censoni-Needham, DMD F Y General Dentist N

Piper Huber, DDS F Y Pediatric Dentist Kaiser Interstate ASC N

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Clackamas Dental Office 10209 SE Sunnyside Road Clackamas, OR. 97015 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Daniela Diaz, DMD F Y General Dentist N Spanish

Desy Wilson, DDS, MS F Y Orthodontist American Board of

Orthodontics (ABoO) N

Jean Marie Pacewic, DMD F Y General Dentist N

Karli Inglis, DDS F Y Pediatric Dentist Kaiser Interstate ASC N

Mailiki L Patterson, DDS F Y General Dentist N

Misty H Fujii-Carr, DDS F Y General Dentist N

Yoshiyuki Charlie Muraki, DMD M Y General Dentist N

Yun Kyung-Lee, DMD F Y General Dentist N Spanish

Eastmoreland Dental Office 5025 SE 28th Ave

Portland, OR. 97202 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

John Worthington, DDS M Y General Dentist N

Jonathan Browning, DDS M Y General Dentist N

Juanita V Boettcher, DMD F Y General Dentist

Kaiser Interstate ASC;

Kaiser Skyline Ambulatory Surgery Center; Kaiser

Sunnyside Medical Center; Kaiser Westside

Medical Center

N

Marcus J van Witzenburg, DMD M Y General Dentist N

Susan Schaumburg Restic

(Schaumburg), DMD F Y General Dentist N

Todd Carris, DMD M Y General Dentist N

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Glisan Dental Office 10102 NE Glisan St Portland, OR. 97220 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Clay L Scarzella, DMD M Y General Dentist N

David M Teeter, DMD M Y Orthodontist N

Farooq Nasserziayee, DMD M Y General Dentist N

Joseph Sease, DMD M Y Pediatric Dentist N

Julie Nielsen, DDS F Y General Dentist N

Lloyd S Chang, DDS M Y General Dentist Kaiser Interstate ASC N

Mark Villanueva, DDS M Y General Dentist N

Minah DeAinza, DDS F Y General Dentist N

Rebecca Guild, DMD F Y General Dentist N

Sarah Heward, DMD F Y Endodontist American Board of

Endodontics (ABoE) N

Tetsuji Z Watari, DDS M Y Periodontist American Board of

Grand Avenue Dental Office 1314 NE Grand Ave

Portland, OR. 97232 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Alison Shisler, DMD F Y General Dentist N

Eric Burgin, DDS M Y Orthodontist N

Heather Fife-Griffin, DMD F Y General Dentist N

Jason R Whitt, DMD M Y General Dentist N

Jennifer A Gilbert, DMD F Y General Dentist N

Lisa J Guerrero, DDS F Y General Dentist N

Megan Erickson (Coker), DDS F Y General Dentist N

Samer Hakimeh, DDS, MS M Y Pediatric Dentist Kaiser Interstate ASC N Arabic, French

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Gresham Dental Office 360 NW Burnside Rd Gresham, OR. 97030 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Elijah Volvovic, DMD M Y General Dentist N

Nhu-Ha Tran, DMD F Y General Dentist N

Steven Justice, DDS M Y General Dentist N

Yangshin Woo, DMD F Y General Dentist N

Kaiser Permanente Building 500 NE Multnomah Suite 100 Portland, OR. 97232

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Felix W Lee, DMD M Y General Dentist N

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Kaiser Permanente Dental at Johnson Creek 9300 SE 91st Ave. Suite 310

Happy Valley, OR. 97086 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Alexis Kleinman, DMD F Y Oral Surgeon

Kaiser Sunnybrook ASC;

Kaiser Sunnyside Medical Center; Kaiser Westside

Medical Center

N

Dennis Cain, M Y Denturist N

Jeffrey Crowley, DMD, MD M Y Oral Surgeon

Medical Center

N

Jennifer Teng, DDS F Y General Dentist N

John A Hill, DDS M Y General Dentist N

Kelly Dezura, DMD F Y Oral Surgeon

American Board of Oral & Maxillofacial Surgery (ABOMS)

Kaiser Sunnybrook ASC;

Medical Center

N

Michael Chang, DDS M Y General Dentist N

Michael Plunkett, DDS M Y General Dentist N

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Kaiser Permanente Dental at Keizer Station 5910 Ulali Drive.

Keizer, OR. 97303 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Benita Wong, DDS, MS F Y Orthodontist N

John A Holland, DDS M Y Oral Surgeon

Kaiser Skyline Ambulatory Surgery Center; Kaiser Sunnybrook ASC; Kaiser Sunnyside Medical Center

N

John N Allen, DMD M Y General Dentist N

Joseph Peck, DMD M Y Endodontist N

Katherine Lane, DMD, MSD F Y Pediatric Dentist

Kaiser Skyline Ambulatory Surgery Center

N

Linda H Le, DDS F Y General Dentist N

Matthew Jervis, DMD M Y General Dentist N

Tristan Wong, DMD M Y General Dentist N

Longview Dental Office 1230 7th Ave

Longview, WA. 98632 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Dylan Sorber, DMD M Y General Dentist N

Ethan S Kaufman, DDS M Y General Dentist N

Justin Tan, DDS M Y General Dentist N

Paul Lytle, DMD M Y General Dentist N

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North Interstate Dental Office 7201 N. Interstate Ave

Portland, OR. 97217 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Benjamin Lively, DDS M Y General Dentist N

David Au-Yeung, DMD M Y Periodontist American Board of

Jimmy J Yoo, DDS M Y General Dentist N

John Oki, DMD M Y General Dentist N

Monica Peterson, DMD F Y General Dentist N

Morgan Towle, DDS F Y General Dentist N

Omid Zarei, M Y Denturist N

North Lancaster Dental Office 2300 Lancaster Dr., NE

Salem, OR. 97305 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Aziz Karam, DMD M Y General Dentist N

Jila Bowman, DDS F Y Periodontist N Farsi

Oswaldo Cantarero, M Y Denturist N

Ryan Randol, DDS Y General Dentist N

Tara G Paluska (Khalil), DDS F Y General Dentist N

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Oregon City Dental Office

1900 SE McLoughlin Blvd Suite 68 Oregon City, OR. 97045

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Carrie L Casper, DMD F Y General Dentist

Kaiser Sunnyside Medical Center

N

John Warner, DMD M Y Pediatric Dentist N

Julia Chang (Dewey), DDS F Y General Dentist N

Keith Herkert, DMD M Y General Dentist Kaiser Interstate ASC N

Richard Bohnstedt, DMD M Y General Dentist N

Robert T McCashew, DDS M Y General Dentist N

Shelby B Setter (Hiles), DDS F Y Pediatric Dentist Kaiser Interstate ASC N

Rockwood Dental Office 822 NE 181st Ave

Portland, OR. 97230 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Aaron Lau, DMD M Y General Dentist N

Jasmine Ju Hyun Cha, DDS F Y General Dentist N

John W Pak, DDS M Y General Dentist N

Peter Nguyen, DMD M Y General Dentist N

Veronika Buliga, F Y Denturist N

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Salmon Creek Dental Office 14406 NE 20th Ave

Vancouver, WA. 98686 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

“Nadia” Nadereh Ghanee, DMD F Y General Dentist N

Angela A Manalili, DMD F Y General Dentist N

Angie Rawley, DMD F Y General Dentist N

Brandt G Monfort, DDS M Y General Dentist N

Glenn Ashworth, DDS M Y General Dentist N

Jessica Adams, DDS, MSD F Y Periodontist American Board of

John Sung Kim, DMD M Y General Dentist N

Matthew Chung, DDS M Y General Dentist N

Peter Ma, DMD M Y General Dentist N

Shawn Fettig, M Y Denturist N

William J Creed, DMD M Y General Dentist N

Skyline Dental Office 5135 Skyline Road South Salem, OR. 97306

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Daniel R Santee, DMD M Y General Dentist N

Eric Peters, DMD M Y General Dentist

Kaiser Skyline Ambulatory Surgery Center

N

Jennifer M Harms, DDS F Y General Dentist N

Rachel Bierma (Jablonski), DMD F Y General Dentist N

Tony Nguyen, DMD M Y General Dentist N

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Tanasbourne Dental Office

10315 NE Tanasbourne Dr. Suite 300 Hillsboro, OR. 97124

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Harold Y Y Young, DMD M Y General Dentist N

Heather Manka, DMD F Y General Dentist N

Huu Vu, DMD M Y General Dentist N

James Bell, DMD M Y General Dentist N

Kelley Stewart Wilson, DMD F Y General Dentist N

Larson Larson Floor, DMD M Y General Dentist N

Lauryn Marks, DMD F Y General Dentist N

Lester C Laraway, DDS M Y Pediatric Dentist Kaiser Interstate ASC N

Matthew G Antony, DDS M Y General Dentist N

May S Kao, DDS F Y General Dentist N

Michael Isaac, DDS M Y Oral Surgeon

American Board of Oral & Maxillofacial Surgery (ABOMS)

N

Phuong “Teresa” Doan, DMD F Y General Dentist N Vietnamese

Thomas L Ratliff, DDS M Y Orthodontist American Board of

Orthodontics (ABoO) N

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Tigard Dental Office 7105 SW Hampton St Tigard, OR. 97223 1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Corey Malensek, DMD M Y General Dentist N

Danny H White, DDS M Y General Dentist N

Greg G Bowers, DMD M Y General Dentist N

Matthew L Shih, DDS M Y General Dentist N

Myron T Peng, DMD M Y General Dentist N

Rie Kimura-Opperman, DMD F Y General Dentist N

Ryan LeClaire, DDS M Y General Dentist N

Valley River Dental

1011 Valley River Way Suite 116B Eugene, OR. 97401

1-800-813-2000

Provider Name

Credential Gender

Accepting New

Referral Required

Kregg L DeLange, DMD M Y General Dentist N

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NONDISCRIMINATION NOTICE

Kaiser Foundation Health Plan of the Northwest (Kaiser Health Plan) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Kaiser Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. We also:

• Provide no cost aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters

• Written information in other formats, such as large print, audio, and accessible electronic formats

• Provide no cost language services to people whose primary language is not English, such as:

• Qualified interpreters

• Information written in other languages

If you need these services, call 1-800-813-2000 (TTY: 711)

If you believe that Kaiser Health Plan has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance by mail or phone at: Member Relations,

Attention: Kaiser Civil Rights Coordinator, 500 NE Multnomah St. Ste 100, Portland, OR 97232, telephone number:

1-800-813-2000.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 1-800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

________________________________________________________________________________________________

HELP IN YOUR LANGUAGE

ATTENTION: If you speak English, language assistance services, free of charge, are available to you.

Call 1-800-813-2000 (TTY: 711).

አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-800-813-2000 (TTY: 711).

ةيبرعلا

(Arabic)

ةظوحلم :

ثدحتت تنك اذإ ةيبرعلا

تامدخ نإف ،

ناجملاب كل رفاوتت ةيوغللا ةدعاسملا .

لصتا مقرب

1-800-813-2000

( : TTY 711 .)

中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-800-813-2000

（TTY：711）。

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60576526_ACA_1557_MarCom_NW_2017_Taglines_Landscape

یسراف

(Farsi)

:هجوت ،دينک یم وگتفگ یسراف نابز هب رگا

.دشاب یم مهارف امش یارب ناگيار تروصب ینابز تلايهست اب

(711 :TTY) 1-800-813-2000

.ديريگب سامت

Français (French) ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-800-813-2000 (TTY: 711).

Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung.

Rufnummer: 1-800-813-2000 (TTY: 711).

日本語 (Japanese) 注意事項：日本語を話される場合、

無料の言語支援をご利用いただけます。1-800-813-2000

（TTY: 711）まで、お電話にてご連絡ください。

ខ្មែរ (Khmer) ប្រយ័ត្ន៖ បរើសិនជាអ្នកនិយាយ ភាសាខ្មែរ, បសវា

ជំនួយខ្ននកភាសា បោយមិនគិត្ឈ្ន ួល គឺអាចមានសំរារ់រំបរ ើ អ្នក។ ចូរ ទូរស័ព្ទ 1-800-813-2000 (TTY: 711)។

한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.

1-800-813-2000 (TTY: 711) 번으로 전화해 주십시오.

ລາວ (Laotian) ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວ ້າພາສາ ລາວ, ການ ບໍລິການຊ່ວຍເຫ ຼືອດ້ານພາສາ, ໂດຍບໍ່ເສັຽຄ່າ, ແມ່ນມີພ້ອມໃຫ້

ທ່ານ. ໂທຣ 1-800-813-2000 (TTY: 711).

Naabeehó (Navajo) Díí baa akó nínízin: Díí saad bee yáníłti’go Diné Bizaad, saad bee áká’ánída’áwo’dé̖é̖’, t’áá jiik’eh, éí ná hóló̖, koji̖’ hódíílnih 1-800-813-2000 (TTY: 711).

Afaan Oromoo (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama.

Bilbilaa 1-800-813-2000 (TTY: 711).

ਪੰਜਾਬੀ (Punjabi) ਧਿਆਨ ਧਿਓ: ਜੇ ਤੁਸੀਂ ਪੰਜਾਬੀ ਬੋਲਿੇ ਹੋ, ਤਾਂ ਭਾਸ਼ਾ

ਧਵਿੱਚ ਸਹਾਇਤਾ ਸੇਵਾ ਤੁਹਾਡੇ ਲਈ ਮੁਫਤ ਉਪਲਬਿ ਹੈ।

1-800-813-2000 (TTY: 711) ' ਤੇ ਕਾਲ ਕਰੋ।

Română (Romanian) ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență

lingvistică, gratuit. Sunați la 1-800-813-2000 (TTY: 711).

Pусский (Russian) ВНИМАНИЕ: если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-800-813-2000 (TTY: 711).

Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia

lingüística. Llame al 1-800-813-2000 (TTY: 711).

Tagalog (Tagalog) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad.

Tumawag sa 1-800-813-2000 (TTY: 711).

ไทย (Thai) เรียน: ถ ้าคุณพูดภาษาไทย คุณสามารถใช ้บริการ ช่วยเหลือทางภาษาได ้ฟรี โทร 1-800-813-2000 (TTY: 711).

Українська (Ukrainian) УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до

безкоштовної служби мовної підтримки. Телефонуйте за номером 1-800-813-2000 (TTY: 711).

Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng

Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho

bạn. Gọi số 1-800-813-2000 (TTY: 711).

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KAISER PERMANENTE NORTHWEST REGION

Kaiser Foundation Health Plan of the Northwest 500 NE Multnomah St., Suite 100

Portland, OR 97232

19416_09-21