Individual
LISA HARDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7105 SW HAMPTON ST, TIGARD, OR 97223-8314
(503) 684-9274
Mailing address
6428 SE 91ST AVE, PORTLAND, OR 97266-5222
(503) 901-5703
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
120494
OR
Other
Enumeration date
01/02/2014
Last updated
01/02/2014
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