Provider Demographics
NPI:1407265879
Name:VRIELING, YURI A
Entity Type:Individual
Prefix:
First Name:YURI
Middle Name:A
Last Name:VRIELING
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 1:3330 SW ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1092
Mailing Address - Country:US
Mailing Address - Phone:503-929-8652
Mailing Address - Fax:
Practice Address - Street 1:3330 SW ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1092
Practice Address - Country:US
Practice Address - Phone:503-929-8652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6772124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist