Healthcare Provider Details

I. General information

NPI: 1699101394
Provider Name (Legal Business Name): KRISTEN M GALLAWAY RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
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:
Mailing address:
  • Phone: 503-941-3033
  • Fax: 503-747-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH6581
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: