Individual
STACY EDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
11820 SW KING JAMES PL, J10, TIGARD, OR 97224-2480
(503) 616-5000
Mailing address
11820 SW KING JAMES PL, J10, TIGARD, OR 97224-2480
(503) 616-5000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D10481
OR
Other
Enumeration date
06/15/2010
Last updated
06/11/2020
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