Provider Demographics
NPI:1588002836
Name:KIRCHEM, DANIELLE (RDH)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:KIRCHEM
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 1:17993 NW EVERGREEN PKWY UNIT 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7680
Mailing Address - Country:US
Mailing Address - Phone:503-577-3587
Mailing Address - Fax:
Practice Address - Street 1:17993 NW EVERGREEN PKWY UNIT 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-7680
Practice Address - Country:US
Practice Address - Phone:503-577-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6151124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist