Provider Demographics
NPI:1821484965
Name:KRASNOGOROV, VERA
Entity Type:Individual
Prefix:
First Name:VERA
Middle Name:
Last Name:KRASNOGOROV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14128 SE SUNSHADOW ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-6582
Mailing Address - Country:US
Mailing Address - Phone:503-805-6597
Mailing Address - Fax:
Practice Address - Street 1:14128 SE SUNSHADOW ST
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-6582
Practice Address - Country:US
Practice Address - Phone:503-805-6597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant