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General NPI Number Information
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NPI Number | 1306115803
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Entity Type | Organization
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Legal Business Name | ESSENTIAL DENTAL HYGIENE, LLC
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Dates
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Enumeration Date | 12/29/2011
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Last Update Date | 12/29/2011
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Provider Practice Location Address
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Address Line | 335 NW 140TH PL
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City | BEAVERTON
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State | OR
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Zip | 97006-6161
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Country | US
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Telephone | 541-815-3985
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Fax |
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Provider Business Mailing Address
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Address Line | 335 NW 140TH PL
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City | BEAVERTON
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State | OR
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Zip | 97006-6161
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Country | US
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Telephone | 541-815-3985
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Fax |
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Authorized Official
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Title or Position | REGISTERED DENTAL HYGIENIST
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Name | HEATHER LEE HUMPHREY
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Credential | RDH, EPDH
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Telephone | 541-815-3985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | H5866
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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 | H5866
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License Number State | OR
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