Provider Demographics
NPI:1366273997
Name:LACHICA, IRENE KAY B (RDH)
Entity type:Individual
Prefix:
First Name:IRENE KAY
Middle Name:B
Last Name:LACHICA
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 1:21110 SW JAY ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97003-6503
Mailing Address - Country:US
Mailing Address - Phone:206-718-2038
Mailing Address - Fax:
Practice Address - Street 1:16155 NW CORNELL RD STE 450
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-8101
Practice Address - Country:US
Practice Address - Phone:971-247-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8896124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty