Individual
MARINA V POLIASHOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220
(503) 238-4418
Mailing address
16038 SE NEHALEM ST, PORTLAND, OR 97236-5387
(503) 473-7778
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H7006
OR
126800000X
Dental Assistant
117669
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H7006
OREGON BOARD OF DENTISTRY
OR
Enumeration date
08/29/2012
Last updated
05/15/2018
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