MEDICARE: KRISTI COULOMBE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D10053	OR
2	124Q00000X	Dental Hygienist	H5021	OR

General Provider Information

NPI Number	:	1487809752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI COULOMBE DMD

Provider Business Mailing Address
First Line	:	1550 NORWAY ST NE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301-0433
Country	:	US
Telephone Number	:	503-588-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	1296 COMMERCIAL ST SE
Second Line	:	SUITE 102
City	:	SALEM
State	:	OR
Zip	:	97302-4200
Country	:	US
Telephone Number	:	503-399-0724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2008
Last Update Date	:	07/08/2014

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Directions to “ KRISTI COULOMBE DMD” Practice Location

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