MEDICARE: RENEE ALEXANDRE BARBARA 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	H4963	OR

General Provider Information

NPI Number	:	1578717567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ALEXANDRE BARBARA RDH

Provider Business Mailing Address
First Line	:	3956 N GANTENBEIN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1419
Country	:	US
Telephone Number	:	503-473-4328
Fax Number	:

Provider Business Practice Location Address
First Line	:	3956 N GANTENBEIN AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1419
Country	:	US
Telephone Number	:	503-473-4328
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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