Provider Demographics
NPI:1114007978
Name:IRWIN, CHRISTINA K
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:K
Last Name:IRWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:CHRISTINA
Other - Middle Name:K
Other - Last Name:IRWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:833 SW 11TH AVE STE 915
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2123
Mailing Address - Country:US
Mailing Address - Phone:503-223-4294
Mailing Address - Fax:503-223-2038
Practice Address - Street 1:833 SW 11TH AVE. STE 915
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2123
Practice Address - Country:US
Practice Address - Phone:503-223-4294
Practice Address - Fax:503-223-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6399122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist