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General NPI Number Information
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NPI Number | 1467517664
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Entity Type | Individual
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Provider Name | LAURIE LEE KELLY RDH
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4550 DOGWOOD DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8410
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Country | US
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Telephone | 503-310-9485
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Fax | 503-620-1635
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Provider Business Mailing Address
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Address Line | 4550 DOGWOOD DR
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-8410
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Country | US
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Telephone | 503-310-9485
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Fax | 503-620-1635
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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 | H2626
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License Number State | OR
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