Healthcare Provider Details

I. General information

NPI: 1366811499
Provider Name (Legal Business Name): TERESA MARIE MCCOMMAS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MCLOUGHLIN BLVD #68 KAISER PERMANENTE OREGON CITY DENTAL OFFICE
OREGON CITY OR
97045
US

IV. Provider business mailing address

1900 MCLOUGHLIN BLVD #68 KAISER PERMANENTE OREGON CITY DENTAL OFFICE
OREGON CITY OR
97045
US

V. Phone/Fax

Practice location:
  • Phone: 503-387-8000
  • Fax: 503-387-8005
Mailing address:
  • Phone: 503-387-8000
  • Fax: 503-387-8005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1918
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: