Healthcare Provider Details

I. General information

NPI: 1649724063
Provider Name (Legal Business Name): BARBARA JOSLIN EPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 08/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3615 EVERGREEN AVE
DEPOE BAY OR
97341-9812
US

IV. Provider business mailing address

3615 EVERGREEN AVE
DEPOE BAY OR
97341-9812
US

V. Phone/Fax

Practice location:
  • Phone: 503-702-0000
  • Fax:
Mailing address:
  • Phone: 503-702-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH3938
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: