Provider Demographics
NPI:1619112893
Name:SCHLOEDER, ELAINE V (RDH)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:V
Last Name:SCHLOEDER
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 1:21300 GOOSENECK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:OR
Mailing Address - Zip Code:97378-9573
Mailing Address - Country:US
Mailing Address - Phone:503-843-3348
Mailing Address - Fax:503-843-3348
Practice Address - Street 1:21300 GOOSENECK CREEK RD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:OR
Practice Address - Zip Code:97378-9573
Practice Address - Country:US
Practice Address - Phone:503-843-3348
Practice Address - Fax:503-843-3348
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH-3797124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist