Individual
DR. MARYANN MCCORMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
5329 NE M L KING BLVD, PORTLAND, OR 97211-3237
(503) 988-3664
Mailing address
5329 NE M L KING BLVD, PORTLAND, OR 97211-3237
(503) 988-3664
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5675
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
125737
—
OR
Enumeration date
09/21/2006
Last updated
07/09/2007
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