Provider Demographics
NPI:1942540166
Name:PILGRIM, NANCY CLAIRE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:CLAIRE
Last Name:PILGRIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12000 SW 49TH AVE
Mailing Address - Street 2:HT 306
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7132
Mailing Address - Country:US
Mailing Address - Phone:971-722-4909
Mailing Address - Fax:
Practice Address - Street 1:12000 SW 49TH AVE
Practice Address - Street 2:HT 306
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7132
Practice Address - Country:US
Practice Address - Phone:971-722-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist