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1043854110
LARISSA VANDERWALL
TIGARD, OR
NPI
1043854110
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
126800000X Dental Assistant
Enumeration Date
2019-11-01
Last Update Date
2019-11-01
Business Address
LARISSA VANDERWALL
7105 SW HAMPTON ST
TIGARD, OR 97223-8314
Phone number: 503-684-9274
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Mailing Address
LARISSA VANDERWALL
7105 SW HAMPTON ST
TIGARD, OR 97223-8314
Phone number: 503-684-9274
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