Individual
SHELLY LEIGH WETZELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTDA
Contact information
Practice address
10209 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9782
(503) 353-3900
Mailing address
7820 SE ASPEN SUMMIT DR, #64, PORTLAND, OR 97266-6155
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
5965855
OR
Other
Enumeration date
02/27/2007
Last updated
07/08/2007
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