Provider Demographics
NPI:1285646182
Name:ROESSLER, LUANN (RDH)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:ROESSLER
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 1:19040 SW BLAINE TER
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3058
Mailing Address - Country:US
Mailing Address - Phone:503-642-4452
Mailing Address - Fax:
Practice Address - Street 1:7105 SW HAMPTON ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8314
Practice Address - Country:US
Practice Address - Phone:503-684-9274
Practice Address - Fax:503-624-9610
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH2406124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist