Individual
MRS. HOLLY JEAN MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
17675 SW TUALATIN VALLEY HWY, BEAVERTON, OR 97006-4443
(503) 259-3169
Mailing address
51468 SE OAK GROVE DR, SCAPPOOSE, OR 97056-4428
(503) 341-6316
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
A5404
OR
Other
Enumeration date
08/05/2008
Last updated
08/05/2008
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