Healthcare Provider Details

I. General information

NPI: 1760499271
Provider Name (Legal Business Name): LORI ANN MITCHELL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10102 NE GLISAN ST
PORTLAND OR
97220-4456
US

IV. Provider business mailing address

5807 RIDGETOP CT
LAKE OSWEGO OR
97035-5712
US

V. Phone/Fax

Practice location:
  • Phone: 503-225-7595
  • Fax:
Mailing address:
  • Phone: 503-620-8278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number1200
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: