Healthcare Provider Details

I. General information

NPI: 1699129874
Provider Name (Legal Business Name): MOLLEE KAY IONE HREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19075 NW TANASBOURNE DR STE 300
HILLSBORO OR
97124-5802
US

IV. Provider business mailing address

17593 NW REINDEER DR
PORTLAND OR
97229-7928
US

V. Phone/Fax

Practice location:
  • Phone: 503-531-1700
  • Fax:
Mailing address:
  • Phone: 503-568-4024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: