Provider Demographics
NPI:1073523403
Name:FARLINGER-KING, JACQUELINE REE (RDH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:REE
Last Name:FARLINGER-KING
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:REE
Other - Last Name:FARLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:803 NE BRAZEE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-4150
Mailing Address - Country:US
Mailing Address - Phone:503-284-9968
Mailing Address - Fax:
Practice Address - Street 1:5025 SE 28TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4445
Practice Address - Country:US
Practice Address - Phone:503-238-4418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1461124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist