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General NPI Number Information
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NPI Number | 1164065280
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Entity Type | Individual
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Provider Name | SVETLANA STEFANOVICH
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Gender | Female
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Dates
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Enumeration Date | 10/21/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 631 JASON ST NE STE 150
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City | SALEM
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State | OR
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Zip | 97301-2357
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Country | US
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Telephone | 503-364-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 4616 HORSESHOE CT SE
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City | SALEM
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State | OR
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Zip | 97317-5593
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Country | US
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Telephone | 503-510-6712
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | H7641
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License Number State | OR
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