Individual
LIDIYA BOGDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
4637 SE 128TH AVE, PORTLAND, OR 97236-3713
(971) 285-0987
Mailing address
4637 SE 128TH AVE, PORTLAND, OR 97236-3713
(971) 285-0987
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-10169937
OR
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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