Individual
FALON NICOLE POUREETEZADI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
360 NW BURNSIDE RD, GRESHAM, OR 97030-3852
(503) 667-7480
Mailing address
900 SE ARROW CREEK LN, GRESHAM, OR 97080-1981
(503) 201-0146
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
120537
OR
Other
Enumeration date
02/27/2015
Last updated
02/27/2015
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