Provider Demographics
NPI:1366610131
Name:MATTFELD, VIRGINIA L (RDH)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:MATTFELD
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 1:10424 SE CHERRY BLOSSOM DR STE I
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2801
Mailing Address - Country:US
Mailing Address - Phone:971-231-4956
Mailing Address - Fax:503-385-0339
Practice Address - Street 1:10424 SE CHERRY BLOSSOM DR STE I
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2801
Practice Address - Country:US
Practice Address - Phone:971-231-4956
Practice Address - Fax:503-385-0339
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4964124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist