Provider Demographics
NPI:1326299918
Name:AUSTIN, VALARIE IRENE (RDH)
Entity Type:Individual
Prefix:MS
First Name:VALARIE
Middle Name:IRENE
Last Name:AUSTIN
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 1:924 SE SHERRETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6935
Mailing Address - Country:US
Mailing Address - Phone:503-233-3638
Mailing Address - Fax:
Practice Address - Street 1:924 SE SHERRETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6935
Practice Address - Country:US
Practice Address - Phone:503-233-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist