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General NPI Number Information
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NPI Number | 1265030811
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Entity Type | Individual
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Provider Name | HAILEY DODSON DMD
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Gender | Female
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 10/15/2020
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Provider Practice Location Address
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Address Line | 907 NW 18TH AVE
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City | PORTLAND
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State | OR
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Zip | 97209-2324
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Country | US
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Telephone | 971-544-7403
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Fax |
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Provider Business Mailing Address
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Address Line | 1926 W BURNSIDE ST UNIT 309
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City | PORTLAND
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State | OR
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Zip | 97209-2068
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Country | US
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Telephone | 541-261-4142
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D11335
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License Number State | OR
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