Provider Demographics
NPI:1205150422
Name:PFEIFER, KELLY MICHELE (RDH, BSDH)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MICHELE
Last Name:PFEIFER
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 1:917 LLOYD CENTER,
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1239
Mailing Address - Country:US
Mailing Address - Phone:503-760-2823
Mailing Address - Fax:
Practice Address - Street 1:917 LLOYD CTR FL 1
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1239
Practice Address - Country:US
Practice Address - Phone:503-760-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4394124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist