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General NPI Number Information
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NPI Number | 1053111062
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Entity Type | Individual
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Provider Name | VINCENT ISAIAS HENRIQUEZ DENTAL HYGIENIST
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Gender | Male
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Dates
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Enumeration Date | 03/18/2025
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Last Update Date | 03/18/2025
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Provider Practice Location Address
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Address Line | 501 SE HAAWTHORNE BLVD. STE 400
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 503-823-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 4102 SE 97TH AVE
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City | PORTLAND
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State | OR
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Zip | 97266-2650
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Country | US
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Telephone | 503-922-9930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | H8922
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License Number State | OR
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