Provider Demographics
NPI:1043040926
Name:HAILE, ANNA (RDH)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HAILE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:BASSETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3518 SW BEAVERTON HILLSDALE HWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97221-3810
Mailing Address - Country:US
Mailing Address - Phone:503-858-8148
Mailing Address - Fax:
Practice Address - Street 1:12600 SW CRESCENT ST STE 190
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1694
Practice Address - Country:US
Practice Address - Phone:503-352-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH8871124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist