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Julie Kolstad Clark
Denturist in Roseburg, Oregon
NPI 1609589837

Julie Kolstad Clark is a Denturist based in Roseburg, OR. Julie Kolstad Clark practices in Roseburg, OR. The NPI Number for Julie Kolstad Clark is 1609589837 and holds a License No. DT-TMP-10228509 (Oregon).

The current practice location address for Julie Kolstad Clark is 150 Ne Kenneth Ford Dr, Roseburg, OR and can be reached out via phone at 541-672-9596.

Location: 150 Ne Kenneth Ford Dr, Roseburg, OR, 97470-4828
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1609589837
Provider Name
Julie Kolstad Clark
Credential
Provider Entity Type
Individual
Gender
Female
Address
150 Ne Kenneth Ford Dr, Roseburg, OR, 97470-4828
Phone Number
541-672-9596
Fax Number
Provider Enumeration Date
01/03/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
150 Ne Kenneth Ford Dr
City
Roseburg
State
Oregon
Zip
97470-1042
Phone Number
541-672-9596
Fax Number
person
Provider Business Mailing Address Details
Address
150 Ne Kenneth Ford Dr
City
Roseburg
State
Oregon
Zip
97470-1042
Phone Number
541-672-9596
Fax Number
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Denturist
Speciality
-
Taxonomy
122400000X
License No.
DT-TMP-10228509 (Oregon)
Definition
Definition to come.
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