Provider Demographics
NPI:1932212719
Name:SALARI-MILLER, MINOO A (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:
First Name:MINOO
Middle Name:A
Last Name:SALARI-MILLER
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:AGHDAS
Other - Middle Name:
Other - Last Name:SALARI MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTAL HYGIENIST
Mailing Address - Street 1:415 N BRIDGETON RD
Mailing Address - Street 2:#1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-8080
Mailing Address - Country:US
Mailing Address - Phone:503-735-9876
Mailing Address - Fax:
Practice Address - Street 1:415 N BRIDGETON RD
Practice Address - Street 2:#1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-8080
Practice Address - Country:US
Practice Address - Phone:503-735-9876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00006375124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist