Provider Demographics
NPI:1013327956
Name:PIATKOFF, ANFISA (RDH, EPP)
Entity Type:Individual
Prefix:
First Name:ANFISA
Middle Name:
Last Name:PIATKOFF
Suffix:
Gender:F
Credentials:RDH, EPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 NE 181ST AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-6666
Mailing Address - Country:US
Mailing Address - Phone:800-683-0855
Mailing Address - Fax:
Practice Address - Street 1:410 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6666
Practice Address - Country:US
Practice Address - Phone:800-683-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6697124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist