Provider Demographics
NPI:1093899304
Name:HO, ANITA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:HO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 SW MONTGOMERY ST APT E
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6089
Mailing Address - Country:US
Mailing Address - Phone:571-215-1355
Mailing Address - Fax:
Practice Address - Street 1:217 W MAIN ST STE 160
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-0450
Practice Address - Country:US
Practice Address - Phone:541-826-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9489309-99261223G0001X
MDMD119751223G0001X
ORD118931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDBH2967985OtherDEA NUMBER