Provider Demographics
NPI:1851636005
Name:HEALTHY SMILES DENTAL HYGIENE CLINIC
Entity Type:Organization
Organization Name:HEALTHY SMILES DENTAL HYGIENE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER /INDEPENDANT DENTAL HYGIENST
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MATTFELD
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:971-231-4959
Mailing Address - Street 1:2262 N ALBINA AVE
Mailing Address - Street 2:SUITE 127
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1703
Mailing Address - Country:US
Mailing Address - Phone:971-231-4959
Mailing Address - Fax:
Practice Address - Street 1:2262 N ALBINA AVE
Practice Address - Street 2:SUITE 127
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1703
Practice Address - Country:US
Practice Address - Phone:971-231-4959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-28
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4964261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental