Provider Demographics
NPI:1558044792
Name:MCCLAIN, ALYSSA JULIANA (DENTAL HYGENIST)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:JULIANA
Last Name:MCCLAIN
Suffix:
Gender:F
Credentials:DENTAL HYGENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4730
Mailing Address - Country:US
Mailing Address - Phone:503-391-2219
Mailing Address - Fax:
Practice Address - Street 1:530 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4730
Practice Address - Country:US
Practice Address - Phone:503-391-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5062124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist