Canada Converse, RDH, LAP, BA
Individual provider Active NPI Dental Hygienist · Bandon, OR
NPI 1972898336 · NPPES record last updated Jun 14, 2011
Key facts
- NPI
- 1972898336
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- H4973 (OR)
- Practice address
- 60140 Seven Devils Rd
Bandon, OR 97411-7358 - Phone
- (541) 260-8082
- NPI assigned
- Jun 14, 2011
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H4973 | OR | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H4973 | OR | Yes |
Addresses
Primary practice location
60140 Seven Devils Rd
Bandon, OR 97411-7358
Mailing address
60140 Seven Devils Rd
Bandon, OR 97411-7358
Phone (541) 260-8082
Other providers in Bandon, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.