Provider Demographics
NPI:1720223316
Name:MANNING STAHL, KATHERINE MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:MARIE
Last Name:MANNING STAHL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:1100 SOUTHGATE
Mailing Address - Street 2:SUITE 17
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-3974
Mailing Address - Country:US
Mailing Address - Phone:541-276-1561
Mailing Address - Fax:
Practice Address - Street 1:1100 SOUTHGATE
Practice Address - Street 2:SUITE 17
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3974
Practice Address - Country:US
Practice Address - Phone:541-276-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5406124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist