Individual
MARILEE J SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH/EPDH
Contact information
Practice address
21186 SAYRE DRIVE, AURORA, OR 97002
(503) 984-2860
Mailing address
PO BOX 34, AURORA, OR 97002-0034
(503) 678-2860
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H0550
OR
Other
Enumeration date
11/21/2011
Last updated
11/21/2011
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