Provider Demographics
NPI:1043690878
Name:ANWAR, QUANITA (RDH, EPDH)
Entity Type:Individual
Prefix:
First Name:QUANITA
Middle Name:
Last Name:ANWAR
Suffix:
Gender:F
Credentials:RDH, EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SW 7TH ST
Mailing Address - Street 2:STE. C
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-4992
Mailing Address - Country:US
Mailing Address - Phone:888-468-0022
Mailing Address - Fax:
Practice Address - Street 1:324 SW 7TH ST
Practice Address - Street 2:STE. C
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-4992
Practice Address - Country:US
Practice Address - Phone:888-468-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-07
Last Update Date:2015-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6838124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist