Provider Demographics
NPI:1912549858
Name:BARAJAS LOPEZ, DIANA GABRIELA (RDH EPDH)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:GABRIELA
Last Name:BARAJAS LOPEZ
Suffix:
Gender:F
Credentials:RDH EPDH
Other - Prefix:MS
Other - First Name:DIANA
Other - Middle Name:GABRIELA
Other - Last Name:BARAJAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3834 SE DORA CT
Mailing Address - Street 2:
Mailing Address - City:TROUTDALE
Mailing Address - State:OR
Mailing Address - Zip Code:97060-2513
Mailing Address - Country:US
Mailing Address - Phone:503-432-5831
Mailing Address - Fax:
Practice Address - Street 1:3834 SE DORA CT
Practice Address - Street 2:
Practice Address - City:TROUTDALE
Practice Address - State:OR
Practice Address - Zip Code:97060-2513
Practice Address - Country:US
Practice Address - Phone:503-432-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7924124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist