Provider Demographics
NPI:1083754667
Name:LEWANDOWSKI-RENEAU, TINA KAY (RDH)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:KAY
Last Name:LEWANDOWSKI-RENEAU
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 1:6955 SW NYBERG ST APT T201
Mailing Address - Street 2:
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-8334
Mailing Address - Country:US
Mailing Address - Phone:541-331-9520
Mailing Address - Fax:
Practice Address - Street 1:16155 NW CORNELL RD STE 450
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8101
Practice Address - Country:US
Practice Address - Phone:503-629-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5151124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist