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General NPI Number Information
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NPI Number | 1003234253
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Entity Type | Organization
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Legal Business Name | AT YOUR DOOR DENTAL
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Dates
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Enumeration Date | 04/04/2014
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Last Update Date | 04/04/2014
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Provider Practice Location Address
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Address Line | 25150 S. LARKIN RD.
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City | BEAVERCREEK
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State | OR
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Zip | 97004
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Country | US
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Telephone | 503-657-0392
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 976
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City | BEAVERCREEK
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State | OR
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Zip | 97004
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Country | US
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Telephone | 503-657-0932
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | MRS. N. ELAINE LANCASTER
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Credential | RDH
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Telephone | 503-277-3270
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H5272
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License Number State | OR
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