Organization
SILVER FALLS DERMATOLOGY, LLC
Active
Other names
FRONTIER DERMATOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
MALISSA KOBBEVIK (CREDENTIALING MANAGER)
(360) 375-2038
Entity
Organization
Contact information
Practice address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Mailing address
1793 13TH ST SE, SALEM, OR 97302-2541
(503) 362-8385
(503) 362-8435
Taxonomy
Speciality
Code
Description
License number
State
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Enumeration date
04/28/2010
Last updated
10/17/2024
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