Provider Demographics
NPI:1942838206
Name:THOMAS, KRISTEN LOREE (RDH)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LOREE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:LOREE
Other - Last Name:MOSES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8885 SW MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7205
Mailing Address - Country:US
Mailing Address - Phone:971-678-0343
Mailing Address - Fax:
Practice Address - Street 1:222 SE 8TH AVE STE 271
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4218
Practice Address - Country:US
Practice Address - Phone:503-352-7373
Practice Address - Fax:503-352-7245
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5909124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORH5909OtherOREGON BOARD OF DENTISTRY