Provider Demographics
NPI:1871580225
Name:MARIAN DE STOPPELAAR DMD PC
Entity type:Organization
Organization Name:MARIAN DE STOPPELAAR DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES OF PC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE STOPPELAAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-786-6895
Mailing Address - Street 1:2305 S E WASHINGTON ST
Mailing Address - Street 2:STE 103
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-7647
Mailing Address - Country:US
Mailing Address - Phone:503-786-6895
Mailing Address - Fax:
Practice Address - Street 1:2305 S E WASHINGTON ST
Practice Address - Street 2:STE 103
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7647
Practice Address - Country:US
Practice Address - Phone:503-786-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR29671223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty