Basic Information
| Provider Information | |||||||||
| NPI: | 1528592656 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STOKER | ||||||||
| FirstName: | AMELIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | WILLAMETTE DENTAL GROUP | ||||||||
| Address2: | 6950 NE CAMPUS WAY | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554336825 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1933 SW JEFFERSON ST | ||||||||
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| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972012405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554336825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2017 | ||||||||
| LastUpdateDate: | 12/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | D10956 | OR | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
No ID Information.