Provider Demographics
NPI:1457631699
Name:BRICKELL, JANIE R (RDH)
Entity Type:Individual
Prefix:
First Name:JANIE
Middle Name:R
Last Name:BRICKELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JANIE
Other - Middle Name:R
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:13066 S WARNOCK RD
Mailing Address - Street 2:OPTIONAL
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9142
Mailing Address - Country:US
Mailing Address - Phone:503-936-7668
Mailing Address - Fax:
Practice Address - Street 1:2513 SW CHERRY PARK RD
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2931
Practice Address - Country:US
Practice Address - Phone:503-492-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5175124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist