Healthcare Provider Details

I. General information

NPI: 1619543154
Provider Name (Legal Business Name): LISA ANN BALINT RDH, EPDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 NE CUMULUS AVE
MCMINNVILLE OR
97128-8805
US

IV. Provider business mailing address

442 GLACIER WAY S
MONMOUTH OR
97361-1761
US

V. Phone/Fax

Practice location:
  • Phone: 150-347-2616
  • Fax:
Mailing address:
  • Phone: 971-712-6158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH8217
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: