Provider Demographics
NPI:1689032229
Name:SAECHAO, NICOLEA
Entity type:Individual
Prefix:
First Name:NICOLEA
Middle Name:
Last Name:SAECHAO
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 1:20810 SW SANDRA LN
Mailing Address - Street 2:
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97003-1845
Mailing Address - Country:US
Mailing Address - Phone:503-964-9553
Mailing Address - Fax:
Practice Address - Street 1:20810 SW SANDRA LN
Practice Address - Street 2:
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97003-1845
Practice Address - Country:US
Practice Address - Phone:503-964-9553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7017124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist