Individual
MISS LAURICE TABITHA COTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Mailing address
11232 NE 135TH AVE, VANCOUVER, WA 98682-2291
(503) 974-5709
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6075
OR
Other
Enumeration date
09/09/2011
Last updated
12/20/2021
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