Individual
KRISTA SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1314 NE GRAND AVE, PORTLAND, OR 97232-1127
(503) 280-2877
Mailing address
4636 SE HENRY ST, PORTLAND, OR 97206-7066
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
119691
OR
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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