Provider Demographics
NPI:1770715005
Name:DAVIDSON, MICHELE R (RDH)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:R
Last Name:DAVIDSON
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 1:3490 LANCASTER DR NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-1356
Mailing Address - Country:US
Mailing Address - Phone:503-540-9041
Mailing Address - Fax:503-540-9056
Practice Address - Street 1:3490 LANCASTER DR NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97305-1356
Practice Address - Country:US
Practice Address - Phone:503-540-9041
Practice Address - Fax:503-540-9056
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5624124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist