Healthcare Provider Details

I. General information

NPI: 1013062595
Provider Name (Legal Business Name): CINDY LOU NONAMAKER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 SE SUNNYSIDE RD
CLACKAMAS OR
97015-9782
US

IV. Provider business mailing address

4490 SE 5TH ST
GRESHAM OR
97080-1858
US

V. Phone/Fax

Practice location:
  • Phone: 503-353-3900
  • Fax:
Mailing address:
  • Phone: 503-666-3832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH3834
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: