Individual
JEAN RAE CUSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
10317 E BURNSIDE ST, 2ND FLOOR, PORTLAND, OR 97216-2733
(503) 988-3905
Mailing address
710 SW 6TH CT, PORTLAND, OR 97219-6562
(503) 293-2895
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
1255
OR
Other
Enumeration date
01/09/2007
Last updated
07/08/2007
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