Provider Demographics
NPI:1699129874
Name:HREN, MOLLEE KAY IONE
Entity type:Individual
Prefix:
First Name:MOLLEE
Middle Name:KAY IONE
Last Name:HREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17593 NW REINDEER DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-7928
Mailing Address - Country:US
Mailing Address - Phone:503-568-4024
Mailing Address - Fax:
Practice Address - Street 1:19075 NW TANASBOURNE DR STE 300
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5802
Practice Address - Country:US
Practice Address - Phone:503-531-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant