Individual
GHEBRE BAHTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16155 NW CORNELL RD STE 450, BEAVERTON, OR 97006-8101
(503) 629-5300
Mailing address
16513 NE 40TH ST, VANCOUVER, WA 98682-5635
(503) 888-5594
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H4571
OR
124Q00000X
Dental Hygienist
HL60004995
WA
Other
Enumeration date
09/07/2016
Last updated
09/07/2016
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