Provider Demographics
NPI:1841632890
Name:WATERS, KAREN ANNETTE (RDH)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ANNETTE
Last Name:WATERS
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 1:1107 NE BURNSIDE RD
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-5710
Mailing Address - Country:US
Mailing Address - Phone:503-665-9616
Mailing Address - Fax:
Practice Address - Street 1:1107 NE BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-5710
Practice Address - Country:US
Practice Address - Phone:503-665-9616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6354124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist