Individual
TRACE DAVID VANCLEAVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
DMD
Contact information
Practice address
603 MEDICAL PKWY, ENTERPRISE, OR 97828-5124
(541) 426-4502
Mailing address
501 2ND ST, LA GRANDE, OR 97850-1118
(541) 786-5337
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D12212
OR
Other
Enumeration date
07/03/2025
Last updated
07/03/2025
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