Provider Demographics
NPI:1174096473
Name:WORTHINGTON, VICTORIA KAYE (EFDA)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:KAYE
Last Name:WORTHINGTON
Suffix:
Gender:F
Credentials:EFDA
Other - Prefix:MRS
Other - First Name:VICTORIA
Other - Middle Name:KAYE
Other - Last Name:HEINTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTDA
Mailing Address - Street 1:9300 SE 91ST AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-3762
Mailing Address - Country:US
Mailing Address - Phone:503-772-7888
Mailing Address - Fax:
Practice Address - Street 1:9300 SE 91ST AVE STE 310
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-3762
Practice Address - Country:US
Practice Address - Phone:503-772-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR93-0798039126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant