Basic Information
| Provider Information | |||||||||
| NPI: | 1902087158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | JOANNA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.D.H. , B.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2425 SE HUDSON CT | ||||||||
| Address2: | |||||||||
| City: | TROUTDALE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970602314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034923217 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13255 SE STARK ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972331548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032551901 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | H3966 | OR | Y | Dental Providers | Dental Hygienist |
No ID Information.