Individual
MRS. LESLIE LUCINDA PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH, OMT
Contact information
Practice address
6590 SW FALLBROOK PL STE 2, BEAVERTON, OR 97008-5465
(503) 922-6636
Mailing address
6590 SW FALLBROOK PL STE 2, BEAVERTON, OR 97008-5465
(503) 922-6636
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
—
—
174400000X
Specialist
Primary
—
—
Other
Enumeration date
04/18/2021
Last updated
04/24/2021
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