MEDICARE: MRS. CATHERINE MARIE ENYEART RDH

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	H2546	OR

General Provider Information

NPI Number	:	1760791149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE MARIE ENYEART RDH

Provider Business Mailing Address
First Line	:	93857 SUNNY HILL LN
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-7529
Country	:	US
Telephone Number	:	541-290-1634
Fax Number	:

Provider Business Practice Location Address
First Line	:	93857 SUNNY HILL LN
Second Line	:
City	:	NORTH BEND
State	:	OR
Zip	:	97459-7529
Country	:	US
Telephone Number	:	541-290-1634
Fax Number	:

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

Provider Enumeration Date	:	10/01/2010
Last Update Date	:	10/01/2010

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