Provider Demographics
NPI:1932473782
Name:RODICH, LALIT KRISTINA (RDH,BSDH,LAP)
Entity Type:Individual
Prefix:MS
First Name:LALIT
Middle Name:KRISTINA
Last Name:RODICH
Suffix:
Gender:F
Credentials:RDH,BSDH,LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 RIVER HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-4039
Mailing Address - Country:US
Mailing Address - Phone:503-367-3061
Mailing Address - Fax:
Practice Address - Street 1:2165 RIVER HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-4039
Practice Address - Country:US
Practice Address - Phone:503-367-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-25
Last Update Date:2012-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4380124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist