Healthcare Provider Details

I. General information

NPI: 1598251688
Provider Name (Legal Business Name): SARA NOELLE WETTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MCLOUGLIN BLVD #68
OREGON CITY OR
97045
US

IV. Provider business mailing address

20088 S REDHOUSE RD
MOLALLA OR
97038-8682
US

V. Phone/Fax

Practice location:
  • Phone: 503-286-6969
  • Fax:
Mailing address:
  • Phone: 503-896-9010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: