Provider Demographics
NPI:1700333804
Name:PICKEL, CHEYENNE NICOLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:NICOLE
Last Name:PICKEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 SE 82ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-6538
Mailing Address - Country:US
Mailing Address - Phone:503-777-0761
Mailing Address - Fax:503-777-0393
Practice Address - Street 1:3580 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-2902
Practice Address - Country:US
Practice Address - Phone:503-777-0761
Practice Address - Fax:503-777-0393
Is Sole Proprietor?:No
Enumeration Date:2016-09-06
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6373124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist