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General NPI Number Information
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NPI Number | 1225317241
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Entity Type | Individual
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Provider Name | CHENOA MARIE MARTIN RDH
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Gender | Female
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 06/22/2020
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Provider Practice Location Address
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Address Line | 9211 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97266-1452
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Country | US
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Telephone | 503-254-2068
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Fax |
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Provider Business Mailing Address
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Address Line | 9211 SE DIVISION ST
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City | PORTLAND
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State | OR
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Zip | 97266-1452
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Country | US
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Telephone | 503-254-2068
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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 | H5908
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH60194052
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License Number State | WA
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