Provider Demographics
NPI:1033563788
Name:FRANK, RISA
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-5001
Mailing Address - Country:US
Mailing Address - Phone:541-432-6555
Mailing Address - Fax:541-432-5051
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846-5001
Practice Address - Country:US
Practice Address - Phone:541-432-6555
Practice Address - Fax:541-432-5051
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6113124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist