Healthcare Provider Details

I. General information

NPI: 1366106957
Provider Name (Legal Business Name): BROOKE HEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16155 NW CORNELL RD STE 450
BEAVERTON OR
97006-8101
US

IV. Provider business mailing address

1221 NE 51ST AVE APT 65
HILLSBORO OR
97124-6084
US

V. Phone/Fax

Practice location:
  • Phone: 503-629-5300
  • Fax:
Mailing address:
  • Phone: 503-260-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8321
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: