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General NPI Number Information
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NPI Number | 1245743921
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Entity Type | Individual
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Provider Name | RACHEL GERMAINE BRODERICK RDH, EPDH
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Gender | Female
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 18650 NW CORNELL RD STE 220
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City | HILLSBORO
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State | OR
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Zip | 97124-9212
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Country | US
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Telephone | 503-848-5861
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Fax | 503-848-5863
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Provider Business Mailing Address
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Address Line | 18650 NW CORNELL RD BLDG C SUITE 220
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City | HILLSBORO
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State | OR
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Zip | 97124-9207
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Country | US
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Telephone | 503-848-5861
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Fax | 503-848-5863
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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 | H7362
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License Number State | OR
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