Individual
SOMCHANH VONGSOURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10626 SE 75TH AVE, MILWAUKIE, OR 97222-2098
(503) 822-0117
Mailing address
10626 SE 75TH AVE, MILWAUKIE, OR 97222-2098
(503) 822-0117
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H4529
OR
Other
Enumeration date
12/08/2025
Last updated
12/08/2025
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