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482 Lancaster Dr Ne Salem OR 97301-4784 | |
| (503) 588-7611 | |
| (503) 588-7551 |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 482 Lancaster Dr Ne, Salem, Oregon |
| Authorized Official Name and Position | Vonny Ngantung (ORTHODONTIST) |
| Authorized Official Contact | 5035887611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
482 Lancaster Dr Ne Salem OR 97301-4784 Ph: (503) 588-7611 | 482 Lancaster Dr Ne Salem OR 97301-4784 Ph: (503) 588-7611 |
| NPI Number | 1497972798 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 08/12/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497972798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | D8294 (Oregon) | Primary |
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