Individual
MRS. MANDY LEANN HANNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 626-4148
Mailing address
660 SE PARKS DR, DUNDEE, OR 97115-9771
(503) 537-4080
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
126800000X
DENTAL
OR
Enumeration date
09/12/2008
Last updated
09/12/2008
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