Healthcare Provider Details

I. General information

NPI: 1376463406
Provider Name (Legal Business Name): DANA MANFULL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 SOUTHVIEW DR
KLAMATH FALLS OR
97603-8545
US

IV. Provider business mailing address

3322 RAYMOND ST
KLAMATH FALLS OR
97603-7050
US

V. Phone/Fax

Practice location:
  • Phone: 541-903-9079
  • Fax:
Mailing address:
  • Phone: 541-601-1768
  • Fax: 541-903-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5211
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: