Provider Demographics
NPI:1356972921
Name:LUO, SHI LI (RDH)
Entity type:Individual
Prefix:
First Name:SHI
Middle Name:LI
Last Name:LUO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:LUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:2743 SE 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-1523
Mailing Address - Country:US
Mailing Address - Phone:503-467-6320
Mailing Address - Fax:
Practice Address - Street 1:10209 SE SUNNYSIDE RD
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9782
Practice Address - Country:US
Practice Address - Phone:503-286-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7695124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist