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Organization
WILLETTEDENTAL
Active
Organization
WILLETTEDENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY CLIFTON (DENTAL HYGIENIST)
(916) 899-9665
Entity
Organization
Contact information
Practice address
4925 SW GRIFFITH DR, BEAVERTON, OR 97005-2923
(916) 899-9665
Mailing address
PO BOX 2000, BEAVERTON, OR 97075-2000
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
H5544
OR
Other
Enumeration date
11/17/2013
Last updated
11/17/2013
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