Provider Demographics
NPI:1770196586
Name:LODGE, SACHA ARIANA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SACHA
Middle Name:ARIANA
Last Name:LODGE
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 1:17065 SHAWNEE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97707
Mailing Address - Country:US
Mailing Address - Phone:541-419-5726
Mailing Address - Fax:
Practice Address - Street 1:17065 SHAWNEE CIRCLE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97707
Practice Address - Country:US
Practice Address - Phone:541-419-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4676124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty