Provider Demographics
NPI:1669047973
Name:THE AESTHETIC
Entity type:Organization
Organization Name:THE AESTHETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDAGE
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, EPDH
Authorized Official - Phone:971-313-1535
Mailing Address - Street 1:325 2ND ST APT 215
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3288
Mailing Address - Country:US
Mailing Address - Phone:971-313-1535
Mailing Address - Fax:
Practice Address - Street 1:410 1ST ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3123
Practice Address - Country:US
Practice Address - Phone:971-313-1535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental