Individual
KATHLEEN MARIE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
17675 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97006-4443
(503) 259-3160
(503) 259-3169
Mailing address
20878 SW EGGERT WAY, ALOHA, OR 97007-2162
(503) 848-7296
(503) 259-3169
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H3677
OR
Other
Enumeration date
11/29/2006
Last updated
07/08/2007
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