Individual
MELISSA DE MATTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
13831 NW CORNELL RD STE C, PORTLAND, OR 97229-5465
(503) 718-3762
Mailing address
PO BOX 11470, EUGENE, OR 97440-3670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11566
OR
1223G0001X
General Practice Dentistry
Primary
D11566
OR
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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