Healthcare Provider Details

I. General information

NPI: 1518970490
Provider Name (Legal Business Name): ADELE F. GOODSELL RDHEF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 NE GRAND AVE
PORTLAND OR
97232-1127
US

IV. Provider business mailing address

10429 SW TITAN LN
TIGARD OR
97224-4411
US

V. Phone/Fax

Practice location:
  • Phone: 503-280-2877
  • Fax:
Mailing address:
  • Phone: 503-620-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2148
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: