Individual
DR. KELLY ANN DEZURA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
10181 SE SUNNYSIDE RD, OTOLARYNGOLOGY (ENT), CLACKAMAS, OR 97015
(510) 571-4727
Mailing address
3717 NE 12TH AVE, PORTLAND, OR 97212-1241
(419) 306-6443
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9858
OR
Other
Enumeration date
07/06/2008
Last updated
08/28/2013
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