MEDICARE: BRIANNA KAY WINTER HANSEN RDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	H6578	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D6578	OTHER	OR	OREGON BOARD OF DENTISTRY

General Provider Information

NPI Number	:	1023843976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANNA KAY WINTER HANSEN RDH

Provider Business Mailing Address
First Line	:	1951 OAK ST STE A
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2005
Country	:	US
Telephone Number	:	503-357-9122
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 OAK ST STE A
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2005
Country	:	US
Telephone Number	:	503-357-9122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2024
Last Update Date	:	09/02/2024

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