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Individual

TATYANA NIKOLAEVNA POLEON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
L.D.

Contact information

Practice address
7931 NE HALSEY ST, SUITE 307, PORTLAND, OR 97213-6755
(360) 216-5931
(503) 252-1214
Mailing address
7931 NE HALSEY ST, SUITE 307, PORTLAND, OR 97213-6755
(360) 216-5931
(503) 252-1214

Taxonomy

Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-10131109
OR

Other

Enumeration date
07/04/2013
Last updated
07/04/2013
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