Provider Demographics
NPI:1861660383
Name:SHOOBRIDGE, STEPHANIE MARIE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:MARIE
Last Name:SHOOBRIDGE
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 1:7334 SE 63RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206
Mailing Address - Country:US
Mailing Address - Phone:503-788-2524
Mailing Address - Fax:
Practice Address - Street 1:4104 SE 82ND AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2954
Practice Address - Country:US
Practice Address - Phone:503-771-4324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5331124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist