Provider Demographics
NPI:1982041356
Name:HERNON, MARION (DMD)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:HERNON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 NE TOWN CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-8915
Mailing Address - Country:US
Mailing Address - Phone:503-207-0510
Mailing Address - Fax:
Practice Address - Street 1:2235 NE TOWN CENTER DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8915
Practice Address - Country:US
Practice Address - Phone:503-207-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-25
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR118761223G0001X
WA607343861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice