Healthcare Provider Details

I. General information

NPI: 1851300222
Provider Name (Legal Business Name): JOAN E. TRAWEEK R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SW HAMPTON ST
TIGARD OR
97223-8314
US

IV. Provider business mailing address

7756 SW LANDAU ST
PORTLAND OR
97223-1030
US

V. Phone/Fax

Practice location:
  • Phone: 503-684-9274
  • Fax:
Mailing address:
  • Phone: 503-293-1604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH1092
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: