Dental Provider Directory
DENTAL PROVIDER DIRECTORY
PUBLISHED JANUARY
2022
THIS DIRECTORY APPLIES TO THE FOLLOWING NETWORKS: CLASSIC, CLASSIC COMPLETE, CLASSIC + DENTAL CHOICE, ADDED CHOICE + DENTAL CHOICE, DENTAL, DENTAL CHOICE
KAISER PERMANENTE NORTHWEST REGION
Listed providers are affiliated with Permanente Dental Associates. The information in this directory is updated monthly. For the most up-todate information, please visit 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 1-800324-8010 (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 dental/nw to search our online directory or call 1-866-498-7912.
The information contained in this directory is accurate as of the January, 2022 publication date. For the most up to date provider directory information, please contact Member Services at 1-800-813-2000 or visit facilities.
If you are looking for a gender affirming treatment provider and can't find a provider close to you, please call our Member Services department at 1-800-813-2000 for help finding an innetwork provider.
19416_01-22
All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St., Suite 100, Portland, OR 97232.
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 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.
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 DMD
Doctor of Dental Surgery 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.
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Dental Providers, Kaiser Permanente, Northwest Region. Providers accepting new members indicated in the Accepting New Members column.
Last updated January 2022. For the most up-to-date information, visit .
For questions or more information, you may contact Member Services via .
ii
Aloha Dental Office 17675 SW Tualatin Valley Highway Beaverton, OR. 97003 1-800-813-2000
Provider Name Credential
Chao Shen, DMD Charles G Row, DDS David K Walker, DMD
Gender M M M
Accepting New
Members
Y
Y
Y
Jay Wylam, DMD
M
Y
Lindsey Gaulke Popov, DMD
F
Y
Nipoon V. Dave, DDS
M
Y
Patrick Heaphy, DMD
M
Y
Specialty General Dentist General Dentist General Dentist
Periodontist
General Dentist General Dentist
Endodontist
Board Certification
American Board of Periodontology (ABoP)
Hospital Affiliations
Referral Languages other Required than English
N N N
N
N N N
Beaverton Dental Office 4855 SW Western Avenue Beaverton, OR. 97005 1-800-813-2000
Provider Name Credential
Deepak Devarajan, DMD Justin Elson, DMD Russel G Leoni, DMD Wendy L Kincaid Smovir, DMD
Gender M M M F
Accepting New
Members Y Y Y Y
Specialty General Dentist General Dentist General Dentist General Dentist
Board Certification
Hospital Affiliations
Referral Languages other Required than English
N N N N
Page 1
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Cascade Park Dental Office 12711 SE Mill Plain Blvd Vancouver, WA. 98684 1-800-813-2000
Provider Name Credential
Aaron S Johnson, DMD David A Straube, DMD
Elizabeth Takamori, DDS
Elly Kim, DDS Emily Passino, DMD Felix W Lee, DMD Jennifer Egli, DDS, MS Johanna L White, DDS Linh T Vo-Cheng, DMD Nikolas E Rawley, DMD Richard Omans, DDS
Gender M M
Accepting New
Members
Y
Y
Specialty General Dentist General Dentist
F
Y
Endodontist
F
Y
General Dentist
F
Y
General Dentist
M
Y
General Dentist
F
Y
Orthodontist
F
Y
General Dentist
F
Y
Pediatric Dentist
M
Y
General Dentist
M
Y
General Dentist
Board Certification
American Board of Endodontics (ABoE)
Hospital Affiliations Kaiser Interstate ASC
Referral Languages other Required than English
N N
N
N
Korean
N
N
N
N
N
N
N
Cedar Hills Dental Office 12450 SW Walker Rd Beaverton, OR. 97005 1-800-813-2000
Provider Name Credential
Andrea Fraser, DDS Cyrus Jeh Lee, DMD Daniel J Pihlstrom, DDS Paula Censoni-Needham, DMD Piper Huber, DDS Tommy Ngo, DMD
Gender F M M F F M
Accepting New
Members Y Y Y Y Y Y
Specialty General Dentist General Dentist General Dentist General Dentist Pediatric Dentist General Dentist
Board Certification
Hospital Affiliations Kaiser Interstate ASC
Referral Languages other Required than English
N N N N N N
Page 2
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Clackamas Dental Office 10209 SE Sunnyside Road Clackamas, OR. 97015 1-800-813-2000
Provider Name Credential
Anh Le, DMD Dean Gretzinger, DDS
Desy Wilson, DDS, MS
Jean Marie Pacewic, DMD Karli Inglis, DDS Mailiki L Patterson, DDS Misty H Fujii-Carr, DDS Yoshiyuki Charlie Muraki, DMD Yun Kyung-Lee, DMD
Gender F M
Accepting New
Members
Y
Y
Specialty General Dentist General Dentist
F
Y
Orthodontist
F
Y
General Dentist
F
Y
Pediatric Dentist
F
Y
General Dentist
F
Y
General Dentist
M
Y
General Dentist
F
Y
General Dentist
Board Certification
American Board of Orthodontics (ABoO)
Hospital Affiliations Kaiser Interstate ASC
Referral Languages other Required than English
N N
N
N
N
N
N
N
N
Spanish
Eastmoreland Dental Office 5025 SE 28th Ave Portland, OR. 97202 1-800-813-2000
Provider Name Credential
Jonathan Browning, DDS
Gender M
Accepting New
Members
Y
Specialty General Dentist
Juanita V Boettcher, DMD
F
Y
General Dentist
Keith Herkert, DMD
M
Marcus J van Witzenburg, DMD
M
Y
General Dentist
Y
General Dentist
Board Certification
Hospital Affiliations
Referral Languages other Required than English
N
Kaiser Interstate ASC;
Kaiser Skyline Ambulatory
Surgery Center; Kaiser Sunnyside Medical
N
Center; Kaiser Westside
Medical Center
Kaiser Interstate ASC
N
N
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