Healthcare Provider Details

I. General information

NPI: 1467818302
Provider Name (Legal Business Name): ALLISON MILES RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 7TH ST
THE DALLES OR
97058-2677
US

IV. Provider business mailing address

2415 E 18TH ST
THE DALLES OR
97058-3985
US

V. Phone/Fax

Practice location:
  • Phone: 541-298-4411
  • Fax:
Mailing address:
  • Phone: 541-993-7110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7050
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: