Individual
MS. JOLENE MOURITSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
5135 SKYLINE RD. S., SALEM, OR 97306
(503) 588-6560
Mailing address
4892 LIBERTY RD. S. #177, SALEM, OR 97306
(503) 378-9404
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
114153
OR
Other
Enumeration date
05/07/2007
Last updated
07/08/2007
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