Provider Demographics
NPI:1366811499
Name:MCCOMMAS, TERESA MARIE (RDH)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIE
Last Name:MCCOMMAS
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 1:1900 MCLOUGHLIN BLVD #68
Mailing Address - Street 2:KAISER PERMANENTE OREGON CITY DENTAL OFFICE
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045
Mailing Address - Country:US
Mailing Address - Phone:503-387-8000
Mailing Address - Fax:503-387-8005
Practice Address - Street 1:1900 MCLOUGHLIN BLVD #68
Practice Address - Street 2:KAISER PERMANENTE OREGON CITY DENTAL OFFICE
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045
Practice Address - Country:US
Practice Address - Phone:503-387-8000
Practice Address - Fax:503-387-8005
Is Sole Proprietor?:No
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH1918124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist