Individual
MONICA ANN LYSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH, BA
Contact information
Practice address
3710 SW US VETERANS RD, PORTLAND, OR 97239
(503) 220-8262
Mailing address
5225 JEAN RD APT 504, LAKE OSWEGO, OR 97035-7155
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H1220
OR
Other
Enumeration date
08/09/2011
Last updated
08/09/2011
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