Provider Demographics
NPI:1003234253
Name:AT YOUR DOOR DENTAL
Entity Type:Organization
Organization Name:AT YOUR DOOR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:N.
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:503-277-3270
Mailing Address - Street 1:PO BOX 976
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97004
Mailing Address - Country:US
Mailing Address - Phone:503-657-0932
Mailing Address - Fax:
Practice Address - Street 1:25150 S. LARKIN RD.
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OR
Practice Address - Zip Code:97004
Practice Address - Country:US
Practice Address - Phone:503-657-0392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5272124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty