Healthcare Provider Details

I. General information

NPI: 1427202167
Provider Name (Legal Business Name): LISA ANN VAHOOMANI RDH, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2008
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 MILL CREEK RD
SHERIDAN OR
97378-9540
US

IV. Provider business mailing address

PO BOX 13760
SALEM OR
97309-1760
US

V. Phone/Fax

Practice location:
  • Phone: 503-409-8731
  • Fax:
Mailing address:
  • Phone: 503-409-8731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2123
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: