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NPI Code Detail

MEDICARE: CLARISSA STONE RDH

MEDICARE: CLARISSA STONE 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
1124Q00000XDental Hygienist1593OR

General Provider Information

NPI Number : 1043234636
Entity Type Code : Individual
Provider Name (Legal Business Name) : CLARISSA STONE RDH
Provider Business Mailing Address
First Line : 891 PLAYER DR N
Second Line :
City : KEIZER
State : OR
Zip : 97303-7468
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2300 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1223
Country : US
Telephone Number : 503-370-7487
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2006
Last Update Date : 07/08/2007

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Directions to “ CLARISSA STONE RDH” Practice Location

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