Individual
DR. IVAN DASSENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6810 CANYON ST SE, SALEM, OR 97317-9024
(503) 581-7379
(503) 585-7816
Mailing address
6810 CANYON ST SE, SALEM, OR 97317-9024
(503) 581-7379
(503) 585-7816
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
6160
OR
Other
Enumeration date
06/01/2007
Last updated
07/08/2007
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