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General NPI Number Information
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NPI Number | 1851636005
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Entity Type | Organization
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Legal Business Name | HEALTHY SMILES DENTAL HYGIENE CLINIC
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Dates
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Enumeration Date | 11/28/2012
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Last Update Date | 12/09/2012
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Provider Practice Location Address
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Address Line | 2262 N ALBINA AVE SUITE 127
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City | PORTLAND
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State | OR
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Zip | 97227-1703
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Country | US
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Telephone | 971-231-4959
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Fax |
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Provider Business Mailing Address
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Address Line | 2262 N ALBINA AVE SUITE 127
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City | PORTLAND
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State | OR
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Zip | 97227-1703
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Country | US
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Telephone | 971-231-4959
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Fax |
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Authorized Official
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Title or Position | OWNER /INDEPENDANT DENTAL HYGIENST
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Name | MRS. VIRGINIA LEE MATTFELD
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Credential | RDH
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Telephone | 971-231-4959
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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 | H4964
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License Number State | OR
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