Individual
THORA JANE STACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDA EFDA
Contact information
Practice address
2300 N.E. LACNCASTER DR., SALEM, OR 97303
(503) 370-4313
Mailing address
4255 CORDON RD NE, SALEM, OR 97305-3738
(503) 370-4313
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
—
—
Other
Enumeration date
05/21/2012
Last updated
05/21/2012
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