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General NPI Number Information
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NPI Number | 1740408525
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Entity Type | Individual
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Provider Name | MARY ELLEN VOLANSKY RDH MS LAP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 107 SE SWAN AVENUE CTSI DENTAL CLINIC
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City | SILETZ
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State | OR
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Zip | 97380
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Country | US
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Telephone | 541-444-9640
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Fax | 541-444-9695
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Provider Business Mailing Address
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Address Line | 807 WEST 26TH AVENUE
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City | EUGENE
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State | OR
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Zip | 97405-2533
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Country | US
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Telephone | 541-342-8676
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Fax | 541-342-8676
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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 | H3649
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0124001
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License Number State | NY
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