Individual
REAGAN RAVANZO BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 813-2000
Mailing address
1771 SE DOWERY LN, HILLSBORO, OR 97123-5090
(971) 227-8773
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
122012
OR
Other
Enumeration date
12/06/2019
Last updated
12/06/2019
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