Individual
JESSICA ELAINE SHELNUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10209 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9782
(503) 353-3905
Mailing address
5025 SE 28TH AVE, PORTLAND, OR 97202-4445
(503) 286-6868
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
000412
OR
Other
Enumeration date
09/19/2019
Last updated
09/19/2019
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