Individual
KATIE LYNN VANDIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DENTAL HYGIENIST
Contact information
Practice address
37389 SCOTT DR, LEBANON, OR 97355-9596
(541) 990-9625
Mailing address
37389 SCOTT DR, LEBANON, OR 97355-9596
(541) 990-9625
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H4783
OR
Other
Enumeration date
07/17/2022
Last updated
07/17/2022
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