Healthcare Provider Details

I. General information

NPI: 1396072658
Provider Name (Legal Business Name): LAURA GRIFFITHS JAUSSI RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 SW VARNS ST STE 102
TIGARD OR
97223-8170
US

IV. Provider business mailing address

17630 SW CEDARVIEW WAY
SHERWOOD OR
97140-8699
US

V. Phone/Fax

Practice location:
  • Phone: 503-670-7260
  • Fax: 503-670-7360
Mailing address:
  • Phone: 503-625-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH3878
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: