Healthcare Provider Details

I. General information

NPI: 1598772287
Provider Name (Legal Business Name): JANINE CATHERINE ROLLINS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5135 SKYLINE RD S
SALEM OR
97306-9427
US

IV. Provider business mailing address

5466 KELLOGG WAY SE
SALEM OR
97317-9563
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-6560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4321
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: