Individual
SHAWNA MOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7105 SW HAMPTON ST, TIGARD, OR 97223-8314
(503) 684-9274
Mailing address
7105 SW HAMPTON ST, TIGARD, OR 97223-8314
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
A10953
OR
Other
Enumeration date
07/17/2013
Last updated
07/17/2013
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