Individual
ASELA AGTAY WELLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4855 SW WESTERN AVE, BEAVERTON, OR 97005-3460
(503) 626-4148
Mailing address
13440 SW CASTLEWOOD ST, BEAVERTON, OR 97005-1203
(971) 344-0288
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
116705
OR
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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