Individual
ANDREA SIVAVAJCHAIPONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1415 PEARL STREET, EUGENE, OR 97401
(541) 344-8302
(541) 343-3494
Mailing address
1415 PEARL STREET, EUGENE, OR 97401
(541) 344-8302
(541) 343-3494
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
62969
CA
1223G0001X
General Practice Dentistry
Primary
D11165
OR
Other
Enumeration date
09/16/2013
Last updated
11/10/2020
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