Individual
DMITRY KEYSALOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7017 SW NYBERG ST, TUALATIN, OR 97062-6243
(503) 612-8736
Mailing address
6682 SW BRISBAND ST, WILSONVILLE, OR 97070-6905
(757) 995-6725
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D11923
OR
Other
Enumeration date
01/17/2017
Last updated
10/09/2024
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