Provider Demographics
NPI:1033634100
Name:HAMPTON, OMA CASANDRA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:OMA
Middle Name:CASANDRA
Last Name:HAMPTON
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 1:7018 NE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4081
Mailing Address - Country:US
Mailing Address - Phone:503-764-9041
Mailing Address - Fax:
Practice Address - Street 1:7018 NE 10TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4081
Practice Address - Country:US
Practice Address - Phone:503-453-2077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-09
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
124Q00000X
ORH4563124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist