Individual
MRS. KRYSTEN ANN CLIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1822 NE 33RD AVE, PORTLAND, OR 97212-5112
(503) 249-0770
Mailing address
2100 NW 113TH AVE, PORTLAND, OR 97229-4808
(503) 643-3173
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H1188
OR
Other
Enumeration date
06/07/2008
Last updated
06/07/2008
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