Provider Demographics
NPI:1003854506
Name:EWRY, LAINE CORINNE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LAINE
Middle Name:CORINNE
Last Name:EWRY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 SE 114TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4966
Mailing Address - Country:US
Mailing Address - Phone:503-760-5463
Mailing Address - Fax:
Practice Address - Street 1:215 SE 102ND AVE
Practice Address - Street 2:SUITE #200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2700
Practice Address - Country:US
Practice Address - Phone:503-253-4700
Practice Address - Fax:503-253-6597
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4365124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist