Healthcare Provider Details

I. General information

NPI: 1609255934
Provider Name (Legal Business Name): OLYA REZAEI-SADRI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NE MAY LN
MCMINNVILLE OR
97128-9272
US

IV. Provider business mailing address

PO BOX 568
CORNELIUS OR
97113-0568
US

V. Phone/Fax

Practice location:
  • Phone: 503-883-4075
  • Fax: 503-883-4764
Mailing address:
  • Phone: 503-352-8657
  • Fax: 503-352-8658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5737
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: