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NPI Code Detail

MEDICARE: MRS. CHRISTINA A ROBLEDO EFDA, PTDA

MEDICARE: MRS. CHRISTINA A ROBLEDO EFDA, PTDA
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
1126800000XDental Assistant112043OR

General Provider Information

NPI Number : 1407963127
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHRISTINA A ROBLEDO EFDA, PTDA
Provider Business Mailing Address
First Line : 7201 N INTERSTATE AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97217-5523
Country : US
Telephone Number : 503-240-4051
Fax Number :
Provider Business Practice Location Address
First Line : NORTH INTERSTATE DENTAL
Second Line : 7201 N INTERSTATE
City : PORTLAND
State : OR
Zip : 97217-5523
Country : US
Telephone Number : 503-240-4051
Fax Number : 503-240-4024
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2006
Last Update Date : 07/12/2007

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