Provider Demographics
NPI:1861401101
Name:CARPENTER, ADRIANA VALLE (RDH)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:VALLE
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-6905
Mailing Address - Country:US
Mailing Address - Phone:503-669-1206
Mailing Address - Fax:503-669-1206
Practice Address - Street 1:822 NE 181ST AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-6708
Practice Address - Country:US
Practice Address - Phone:503-661-5210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH1915124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist