Individual
KELSEY TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
12450 SW WALKER RD, BEAVERTON, OR 97005-1401
(503) 277-1050
Mailing address
12450 SW WALKER RD, BEAVERTON, OR 97005-1401
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
117418
OR
Other
Enumeration date
01/21/2020
Last updated
01/21/2020
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