Individual
HALEY DIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1401 NW 1ST ST # 120, BATTLE GROUND, WA 98604-4540
(360) 666-5700
Mailing address
638 NE 79TH AVE, PORTLAND, OR 97213-6913
(540) 392-1820
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
61314756
WA
Other
Enumeration date
07/04/2022
Last updated
07/04/2022
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