Healthcare Provider Details

I. General information

NPI: 1841642287
Provider Name (Legal Business Name): VERONIKA BULIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6842 SE 66TH AVE
PORTLAND OR
97206-7449
US

IV. Provider business mailing address

6842 SE 66TH AVE
PORTLAND OR
97206-7449
US

V. Phone/Fax

Practice location:
  • Phone: 971-274-9695
  • Fax:
Mailing address:
  • Phone: 971-274-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDT-DO-10177649
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: