Provider Demographics
NPI:1609529049
Name:OSAWA, JENNIFER ELEANOR (RHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELEANOR
Last Name:OSAWA
Suffix:
Gender:F
Credentials:RHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16790 SW 113TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3427
Mailing Address - Country:US
Mailing Address - Phone:503-784-5155
Mailing Address - Fax:
Practice Address - Street 1:16790 SW 113TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-3427
Practice Address - Country:US
Practice Address - Phone:503-784-5155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8368124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist