Individual
KAYVANDOKHT FUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
19075 NW TANASBOURNE DR STE 300, HILLSBORO, OR 97124-5860
(503) 531-1700
Mailing address
11894 SW ASPEN RIDGE DR, TIGARD, OR 97224-2561
(503) 598-0672
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H2379
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124Q00000X
DENTAL HYGIENIST
OR
Enumeration date
08/08/2006
Last updated
07/08/2007
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