Individual
MS. SUSAN MARY STOVALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DENTURIST LD
Contact information
Practice address
16130 SE 82ND DRIVE, SWISS DENTURE CENTER, CLACKAMAS, OR 97014
(503) 657-6500
(503) 557-0412
Mailing address
16130 SE 82ND DRIVE, SWISS DENTURE CENTER, CLACKAMAS, OR 97015-9587
(503) 657-6500
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT DO 981893
OR
Other
Enumeration date
06/29/2007
Last updated
07/08/2007
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