Individual
DR. MICHELLE D STAFFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
11790 SW BARNES RD BLDG A, SUITE 280, PORTLAND, OR 97225-5934
(503) 555-5555
Mailing address
11790 SW BARNES RD BLDG A, SUITE 280, PORTLAND, OR 97225-5934
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
D9074
OR
Other
Enumeration date
05/16/2008
Last updated
05/16/2008
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