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General NPI Number Information
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NPI Number | 1144474131
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Entity Type | Individual
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Provider Name | GEORGINA ANDRIST RDH
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 1244 SE 122ND AVE
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City | PORTLAND
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State | OR
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Zip | 97233-1202
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Country | US
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Telephone | 503-913-0850
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Fax |
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Provider Business Mailing Address
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Address Line | 1244 SE 122ND AVE
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City | PORTLAND
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State | OR
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Zip | 97233-1202
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Country | US
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Telephone | 503-913-0850
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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 | H5462
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License Number State | OR
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