Individual
DR. LAURISSA MARIE CHAMPION
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
2115 NE 42ND AVE, PORTLAND, OR 97213-1321
(503) 954-1372
(503) 954-1392
Mailing address
2115 NE 42ND AVE, PORTLAND, OR 97213-1321
(503) 954-1372
(503) 954-1392
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D8555
OR
Other
Enumeration date
10/06/2006
Last updated
09/15/2008
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