Individual
KELLY SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
7700 SW GARDEN HOME RD APT 24, PORTLAND, OR 97223-7496
(503) 954-5321
Mailing address
2020 SE 182ND AVE, PORTLAND, OR 97233-5692
(503) 954-5321
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H5548
OR
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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