Provider Demographics
NPI:1225458466
Name:STRAWN, DESIREE
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:STRAWN
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 1:5975 SW CHINOOK LN
Mailing Address - Street 2:
Mailing Address - City:CULVER
Mailing Address - State:OR
Mailing Address - Zip Code:97734-9707
Mailing Address - Country:US
Mailing Address - Phone:907-841-0019
Mailing Address - Fax:
Practice Address - Street 1:5975 SW CHINOOK LN
Practice Address - Street 2:
Practice Address - City:CULVER
Practice Address - State:OR
Practice Address - Zip Code:97734-9707
Practice Address - Country:US
Practice Address - Phone:907-841-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-25
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6290124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist