Basic Information
| Provider Information | |||||||||
| NPI: | 1801512462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TOMAS | ||||||||
| FirstName: | CHARLEEN | ||||||||
| MiddleName: | YUKARI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15585 SW STONE RIDGE CIR | ||||||||
| Address2: | |||||||||
| City: | BEAVERTON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970076698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032081510 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 222 SE 8TH AVE | ||||||||
| Address2: | |||||||||
| City: | HILLSBORO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971234218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033526151 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2022 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | Y | Dental Providers | Dental Hygienist |
No ID Information.