Provider Demographics
NPI:1609557040
Name:MCQUISTON, KARLY MARIE (RDH, EPP)
Entity Type:Individual
Prefix:
First Name:KARLY
Middle Name:MARIE
Last Name:MCQUISTON
Suffix:
Gender:F
Credentials:RDH, EPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18833 LODGEPOLE WAY
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-7695
Mailing Address - Country:US
Mailing Address - Phone:150-357-5810
Mailing Address - Fax:
Practice Address - Street 1:18833 LODGEPOLE WAY
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-7695
Practice Address - Country:US
Practice Address - Phone:503-575-8102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8139124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist