Individual
ELIZABETH AMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
324 SW 7TH ST, NEWPORT, OR 97365-4992
(503) 507-3588
Mailing address
2433 NW LOVEJOY ST, PORTLAND, OR 97210-3023
(503) 507-3588
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12051
OR
124Q00000X
Dental Hygienist
H6799
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D12051
OREGON BOARD OF DENTISTRY
OR
Enumeration date
08/21/2014
Last updated
07/23/2024
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