Healthcare Provider Details

I. General information

NPI: 1205080843
Provider Name (Legal Business Name): PAMELA JEAN LYNCH RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SW LINCOLN ST APT 1214
PORTLAND OR
97201-5032
US

IV. Provider business mailing address

8495 SW HEMLOCK ST APT C
TIGARD OR
97223-5837
US

V. Phone/Fax

Practice location:
  • Phone: 541-643-4152
  • Fax:
Mailing address:
  • Phone: 541-643-4152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberIL 60127826
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberCOS-FT-10125043
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4846
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberRDH22343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: