Provider Demographics
NPI:1497155063
Name:PRIESTER, MICHELLE HOANG (DMD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:HOANG
Last Name:PRIESTER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:HOANG
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97007-0149
Mailing Address - Country:US
Mailing Address - Phone:503-352-8657
Mailing Address - Fax:503-434-8597
Practice Address - Street 1:12600 SW CRESCENT ST STE 106
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1693
Practice Address - Country:US
Practice Address - Phone:503-718-3675
Practice Address - Fax:503-434-8597
Is Sole Proprietor?:No
Enumeration Date:2014-09-01
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORPENDINGMedicaid
ORPENDINGMedicare PIN