Basic Information
| Provider Information | |||||||||
| NPI: | 1952529661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LACRAMPE | ||||||||
| FirstName: | ETIENNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11982 NE GLISAN ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972202143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032578787 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1844 SAN MIGUEL DR STE 209 | ||||||||
| Address2: | |||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945964913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259376350 | ||||||||
| FaxNumber: | 9259376352 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2007 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 58771 | CA | Y | Dental Providers | Dentist | Periodontics |
No ID Information.