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Contact Information

4342 LIBERTY RD S
SALEM, OR97302-6171
 Phone: 503-363-6500
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Endodontics

1223E0200X
Indicates primary specialty

NPI Profile & details for · (Female)

NPI # 1922647312
Status Active
Credentials
Entity Individual
Enumeration date 01/02/2020
Last updated 01/02/2020 - About 6 years ago
Sole proprietor 1 Not specified
Identifiers
  • Other 4342 OWNER
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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