Provider Demographics
NPI:1457818783
Name:MOORE, KATHRYN PARSONS (RDH, MS)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:PARSONS
Last Name:MOORE
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43360 NW DIERICKX RD
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-8179
Mailing Address - Country:US
Mailing Address - Phone:503-944-9732
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE STE 271
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-944-9732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH1717124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist