Individual
JENI WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5935 SE ALEXANDER ST, HILLSBORO, OR 97123-8575
(503) 848-2385
Mailing address
16039 SW BRIDLE HILLS DR, BEAVERTON, OR 97007-4933
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H5875
OR
Other
Enumeration date
01/09/2013
Last updated
01/09/2013
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