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General NPI Number Information
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NPI Number | 1497147185
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Entity Type | Individual
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Provider Name | ROXANE TUNTLAND RDH
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Gender | Female
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Dates
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Enumeration Date | 03/04/2015
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Last Update Date | 03/04/2015
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Provider Practice Location Address
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Address Line | 1275 SW 158TH AVE
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City | BEAVERTON
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State | OR
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Zip | 97006-6043
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Country | US
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Telephone | 503-641-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 36TH AVE
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City | FOREST GROVE
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State | OR
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Zip | 97116-5025
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Country | US
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Telephone | 971-645-3521
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H6401
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License Number State | OR
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