Provider Demographics
NPI:1134366222
Name:PHILLIPS, KAREN (RDH, LAP, BSDH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:RDH, LAP, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7710 SW BARNARD DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-4967
Mailing Address - Country:US
Mailing Address - Phone:503-641-0760
Mailing Address - Fax:
Practice Address - Street 1:7710 SW BARNARD DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-4967
Practice Address - Country:US
Practice Address - Phone:503-641-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3574124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist