Individual
LENORE SUPNET
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
3740 SE 122ND AVE, PORTLAND, OR 97236-3405
(503) 762-2525
(503) 762-4872
Mailing address
3740 SE 122ND AVE, PORTLAND, OR 97236-3405
(503) 762-2525
(503) 762-4872
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7895
OR
Other
Enumeration date
08/09/2005
Last updated
07/08/2007
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