Individual
BETHANY KAY WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Mailing address
10102 NE GLISAN ST, PORTLAND, OR 97220-4456
(503) 257-5959
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
122468
OR
Other
Enumeration date
01/02/2019
Last updated
01/02/2019
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