Provider Demographics
NPI:1154741445
Name:WILSON, CHRISTINA LEE (RDH,BSDH)
Entity type:Individual
Prefix:MISS
First Name:CHRISTINA
Middle Name:LEE
Last Name:WILSON
Suffix:
Gender:F
Credentials:RDH,BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 SE FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-6435
Mailing Address - Country:US
Mailing Address - Phone:503-869-7859
Mailing Address - Fax:
Practice Address - Street 1:4925 SW GRIFFITH DR
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2923
Practice Address - Country:US
Practice Address - Phone:503-277-2014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5871124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist