Provider Demographics
NPI:1609926799
Name:MALIN, SUZANNE SCARTON (RDH)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:SCARTON
Last Name:MALIN
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 1:1627 NE 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2703
Mailing Address - Country:US
Mailing Address - Phone:503-750-8322
Mailing Address - Fax:
Practice Address - Street 1:10317 E BURNSIDE ST FL 2
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2733
Practice Address - Country:US
Practice Address - Phone:503-988-3905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3948124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist