Healthcare Provider Details

I. General information

NPI: 1013084342
Provider Name (Legal Business Name): SIMONA HUTANU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17675 SW TUALATIN VALLEY HWY
BEAVERTON OR
97006-4443
US

IV. Provider business mailing address

15875 SW KESTREL CT
BEAVERTON OR
97007-9200
US

V. Phone/Fax

Practice location:
  • Phone: 503-259-3160
  • Fax:
Mailing address:
  • Phone: 503-515-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5122
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: