Provider Demographics
NPI:1053111062
Name:HENRIQUEZ, VINCENT ISAIAS (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:ISAIAS
Last Name:HENRIQUEZ
Suffix:
Gender:
Credentials:DENTAL HYGIENIST
Other - Prefix:MR
Other - First Name:VINCENT
Other - Middle Name:ISAIAS
Other - Last Name:HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:VINCENT RDH, EPDH
Mailing Address - Street 1:4102 SE 97TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-2650
Mailing Address - Country:US
Mailing Address - Phone:503-922-9930
Mailing Address - Fax:
Practice Address - Street 1:501 SE HAAWTHORNE BLVD. STE 400
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-823-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8922124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist