Individual
MARIAM MENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BDS, MSOFPOM
Contact information
Practice address
618 SE 141ST AVE, PORTLAND, OR 97233-2208
(503) 888-9538
Mailing address
618 SE 141ST AVE, PORTLAND, OR 97233-2208
(503) 888-9538
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
61069699
WA
1223X2210X
Orofacial Pain Dentistry
61069699
WA
Other
Enumeration date
01/29/2021
Last updated
01/29/2021
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