Provider Demographics
NPI:1467865956
Name:TRICKEY, LINDA SUE (RDH, BSC)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:SUE
Last Name:TRICKEY
Suffix:
Gender:F
Credentials:RDH, BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0640
Mailing Address - Country:US
Mailing Address - Phone:541-463-5206
Mailing Address - Fax:
Practice Address - Street 1:2460 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-0640
Practice Address - Country:US
Practice Address - Phone:541-463-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5415124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist