Individual
MRS. JUSTINE E WALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10209 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9782
(800) 813-2000
Mailing address
1352 NW ST, ESTACADA, OR 97023
(509) 756-6999
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
122616
OR
Other
Enumeration date
01/14/2022
Last updated
01/14/2022
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