Individual
VANESSA JOAN GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7201 N INTERSTATE AVE, PORTLAND, OR 97217-5523
(503) 240-4051
Mailing address
7201 N INTERSTATE AVE, PORTLAND, OR 97217-5523
(503) 240-4051
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
930798039
OR
Other
Enumeration date
04/26/2019
Last updated
04/26/2019
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