Individual
ANUPRABHA SHRIVASTAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5175 NE MARTIN LUTHER KING JR BLVD STE 110, PORTLAND, OR 97211-3233
(503) 406-1108
Mailing address
5175 NE MARTIN LUTHER KING JR BLVD STE 110, PORTLAND, OR 97211-3233
(503) 406-1108
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11342
OR
1223G0001X
General Practice Dentistry
Primary
D11342
OR
Other
Enumeration date
09/25/2020
Last updated
12/12/2021
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