Provider Demographics
NPI:1568265510
Name:ANDERSON, CORRIE ANN (RDH)
Entity type:Individual
Prefix:
First Name:CORRIE
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:
Credentials:RDH
Other - Prefix:
Other - First Name:CORRIE
Other - Middle Name:ANN
Other - Last Name:MOXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7320 SW HUNZIKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-2302
Mailing Address - Country:US
Mailing Address - Phone:503-941-3077
Mailing Address - Fax:
Practice Address - Street 1:3300 SE DWYER DR STE 302
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-6548
Practice Address - Country:US
Practice Address - Phone:503-850-4479
Practice Address - Fax:503-850-4481
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7955124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist