Provider Demographics
NPI:1881090397
Name:ARCHER, IRINA V (RDH)
Entity type:Individual
Prefix:
First Name:IRINA
Middle Name:V
Last Name:ARCHER
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 1:10006 NE ALTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-3626
Mailing Address - Country:US
Mailing Address - Phone:503-956-2050
Mailing Address - Fax:
Practice Address - Street 1:10006 NE ALTON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3626
Practice Address - Country:US
Practice Address - Phone:503-956-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6877124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist