Individual
MELISSA J WAGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(907) 942-2491
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(907) 942-2491
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1156
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DD54881
—
AK
Enumeration date
10/06/2006
Last updated
07/02/2013
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