Individual
BEVERLY VERNWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LD
Contact information
Practice address
2905 SE OAK GROVE BLVD, SUITE 3, MILWAUKIE, OR 97267-1300
(503) 654-4583
Mailing address
7121 N SWIFT ST, PORTLAND, OR 97203-1368
(503) 289-5862
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO694389
OR
Other
Enumeration date
05/02/2007
Last updated
07/08/2007
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