Provider Demographics
NPI:1497906317
Name:SHUMSKIY, IRINA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:IRINA
Middle Name:
Last Name:SHUMSKIY
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 1:11050 SE POWELL BLVD
Mailing Address - Street 2:SUITE 378
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1863
Mailing Address - Country:US
Mailing Address - Phone:503-788-0405
Mailing Address - Fax:
Practice Address - Street 1:11050 SE POWELL BLVD
Practice Address - Street 2:SUITE 378
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-1863
Practice Address - Country:US
Practice Address - Phone:503-788-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4847124Q00000X
CARDH 22690124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist