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Provider Information for 1952329526

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1952329526

Calendar   Last Updated:  2016-11-16
  Certification Date: 


Name Value
NPI 1952329526
Enumeration Date 2006-07-18
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 14425 SW ALLEN BLVD SUITE 200
BEAVERTON, OR 97005-4402
United States

Phone: 503-646-5909 | Fax: 503-646-5909
View Map External Link
Primary Practice Address 4970 SW MAIN AVE SUITE 200
BEAVERTON, OR 97005-2740
United States

Phone: 503-646-5909 | Fax: 503-646-5908
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice OR D8510