Individual
MS. SHANDA MAYA BARRETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3027 NE 12TH AVE, PORTLAND, OR 97212-3251
(503) 757-7375
Mailing address
3027 NE 12TH AVE, PORTLAND, OR 97212-3251
(503) 757-7375
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6406
OR
Other
Enumeration date
12/10/2012
Last updated
12/10/2012
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