Healthcare Provider Details

I. General information

NPI: 1285646182
Provider Name (Legal Business Name): LUANN ROESSLER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SW HAMPTON ST
TIGARD OR
97223-8314
US

IV. Provider business mailing address

19040 SW BLAINE TER
ALOHA OR
97006-3058
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-9274
  • Fax: 503-624-9610
Mailing address:
  • Phone: 503-642-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2406
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: