Individual
JULIE KOLSTAD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
150 NE KENNETH FORD DR, ROSEBURG, OR 97470-1042
(541) 672-9596
Mailing address
847 SE BLAKELEY AVE, ROSEBURG, OR 97470-4828
(541) 817-2181
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-TMP-10228509
OR
Other
Enumeration date
01/03/2023
Last updated
01/03/2023
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