Healthcare Provider Details

I. General information

NPI: 1801700570
Provider Name (Legal Business Name): MITCHELL LOPEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 SE ROBIN CIR
HILLSBORO OR
97123-8256
US

IV. Provider business mailing address

3085 SE ROBIN CIR
HILLSBORO OR
97123-8256
US

V. Phone/Fax

Practice location:
  • Phone: 503-400-8466
  • Fax:
Mailing address:
  • Phone: 503-400-8466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH9379
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: