MEDICARE: NATASHA CRISMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H6920	OR

General Provider Information

NPI Number	:	1730734823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATASHA CRISMAN

Provider Business Mailing Address
First Line	:	1782 BROADWAY ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-1458
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 COMMERCIAL ST SE STE 101
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-585-4282
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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Directions to “ NATASHA CRISMAN ” Practice Location

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