Provider Demographics
NPI:1043716731
Name:VANDERWERF, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:VANDERWERF
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 1:1748 NW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-2979
Mailing Address - Country:US
Mailing Address - Phone:907-957-0165
Mailing Address - Fax:
Practice Address - Street 1:2501 NE CENTURY BLVD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5506
Practice Address - Country:US
Practice Address - Phone:503-444-0096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6786124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty