Healthcare Provider Details

I. General information

NPI: 1568094696
Provider Name (Legal Business Name): ELIZABETH NADIA OSINTSEV RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 NE GRAND AVE
PORTLAND OR
97232-1127
US

IV. Provider business mailing address

6916 SE QUEEN RD
MILWAUKIE OR
97222-2314
US

V. Phone/Fax

Practice location:
  • Phone: 503-286-6868
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7497
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: