Individual
DR. MARY F STAVROPOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2730 SW MOODY AVE, PORTLAND, OR 97201
(608) 769-4364
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7015
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
D10449
OR
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DTP 113
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
S68
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
366627
MEDICARE
OR
Enumeration date
04/27/2006
Last updated
03/07/2023
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