Basic Information
| Provider Information | |||||||||
| NPI: | 1962917724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRENNAN | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | RDH, BSDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13026 SE CREEKSIDE TER | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970866232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035023481 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9300 SE 91ST AVE STE 310 | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970863762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038132000 | ||||||||
| FaxNumber: | 5037727885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2017 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | H6061 | OR | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | H6061 | 01 | OR | OREGON BOARD OF DENTISTRY | OTHER |