Jean Rae Custer
Dental Hygienist
10317 E Burnside St 2nd Floor
Portland
, Oregon 97216-2733
Jean Rae Custer
Dental Hygienist
10317 E Burnside St 2nd Floor
Portland
, Oregon 97216-2733
(503) 293-2895
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About
Features
Specialties
- Dental Hygienist
Languages spoken
- English
Location
First Address
- Jean Rae Custer
- 710 Sw 6th Ct
- Portland, OR
- Zip : 97219-6562
- Phone : (503) 293-2895
Second Address
- Jean Rae Custer
- 10317 E Burnside St 2nd Floor
- Portland, OR
- Zip : 97216-2733
- Phone : (503) 988-3905
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 124Q00000X | Dental Hygienist | 1255 | OR |
National Provider Identifier
| NPI | 1013066976 |
|---|---|
| Provider Name | Jean Rae Custer |
| First Address | Portland, OR 97219-6562 |
| Second Address | Portland, OR 97216-2733 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 09/01/2007 |
| Last Update Date | 08/07/2007 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.