Individual
MIROSLAW ANTONI ZYCHLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTURIST
Contact information
Practice address
6950 NE CAMPUS WAY, HILLSBORO, OR 97124-5611
(800) 460-7644
(503) 952-2264
Mailing address
6207 LOUISIANA DR, VANCOUVER, WA 98661-7521
(360) 696-4265
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-163846
OR
Other
Enumeration date
05/03/2007
Last updated
07/08/2007
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