Individual
NICHOLE DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15053 NW NIGHTSHADE DR, PORTLAND, OR 97229-1578
(503) 200-4291
Mailing address
15053 NW NIGHTSHADE DR, PORTLAND, OR 97229-1578
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6353
OR
Other
Enumeration date
06/10/2014
Last updated
06/10/2014
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