Healthcare Provider Details

I. General information

NPI: 1568265510
Provider Name (Legal Business Name): CORRIE ANN ANDERSON RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORRIE ANN MOXON

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 SE DWYER DR STE 302
MILWAUKIE OR
97222-6548
US

IV. Provider business mailing address

7320 SW HUNZIKER RD STE 300
PORTLAND OR
97223-2302
US

V. Phone/Fax

Practice location:
  • Phone: 503-850-4479
  • Fax: 503-850-4481
Mailing address:
  • Phone: 503-941-3077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7955
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: