Individual
LORETTA EILEEN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4077 NE 2ND ST, GRESHAM, OR 97030-1711
(503) 780-1510
Mailing address
4077 NE 2ND ST, GRESHAM, OR 97030-1711
(503) 780-1510
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H2367
OR
Other
Enumeration date
06/21/2017
Last updated
07/21/2022
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