Provider Demographics
NPI:1972605947
Name:MORGAN, HOLLY BROOKE (RDH)
Entity Type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BROOKE
Last Name:MORGAN
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 1:500 NE MULTNOMAH STREET.
Mailing Address - Street 2:DENTAL ADMINISTRATION
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232
Mailing Address - Country:US
Mailing Address - Phone:503-869-2735
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST.
Practice Address - Street 2:DENTAL ADMINISTRATION
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232
Practice Address - Country:US
Practice Address - Phone:503-869-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3081124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist