=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396072658
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA GRIFFITHS JAUSSI RDH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2009
-----------------------------------------------------
Last Update Date | 11/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7145 SW VARNS ST STE 102
-----------------------------------------------------
City | TIGARD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-8170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-670-7260
-----------------------------------------------------
Fax | 503-670-7360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17630 SW CEDARVIEW WAY
-----------------------------------------------------
City | SHERWOOD
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97140-8699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-625-8004
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | H3878
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------