Provider Demographics
NPI:1609584028
Name:CARDENAS, IRIS ANNEL (RDH)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:ANNEL
Last Name:CARDENAS
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 1:1307 TRENT AVE N
Mailing Address - Street 2:
Mailing Address - City:KEIZER
Mailing Address - State:OR
Mailing Address - Zip Code:97303-7617
Mailing Address - Country:US
Mailing Address - Phone:503-330-0862
Mailing Address - Fax:
Practice Address - Street 1:2737 LANCASTER DR NE STE 150
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-4134
Practice Address - Country:US
Practice Address - Phone:503-364-9422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8207124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist