Individual
LESLIE FABIOLA MORENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
600 NE 8TH ST STE 210, GRESHAM, OR 97030-7341
(503) 988-4900
Mailing address
5020 NE KILLINGSWORTH ST APT 106, PORTLAND, OR 97218-1991
(503) 896-0240
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
120307
OR
Other
Enumeration date
07/02/2020
Last updated
07/02/2020
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