Individual
BOONYAPA PURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1046 NE 3RD ST, MCMINNVILLE, OR 97128-4418
(503) 472-1468
Mailing address
1046 NE 3RD ST, MCMINNVILLE, OR 97128-4418
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D10055
OR
Other
Enumeration date
06/25/2014
Last updated
08/10/2022
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