Healthcare Provider Details

I. General information

NPI: 1952970352
Provider Name (Legal Business Name): ADRIANA CANDACE REPPELL DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 DELTA OAKS DR STE 300
EUGENE OR
97408-1700
US

IV. Provider business mailing address

6950 NE CAMPUS WAY
HILLSBORO OR
97124-5611
US

V. Phone/Fax

Practice location:
  • Phone: 855-433-6825
  • Fax:
Mailing address:
  • Phone: 855-433-6825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11452
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: