Individual
SITA LISA PING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2381 NE CONNERS AVE, BEND, OR 97701-6068
(541) 678-6262
Mailing address
10505 SE 17TH AVE, PORTLAND, OR 97222-7475
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
NA
OR
1223G0001X
General Practice Dentistry
D10729
OR
1223P0221X
Pediatric Dentistry
Primary
D10729
OR
Other
Enumeration date
08/30/2017
Last updated
06/08/2021
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