Ivan Dassenko MD

NPI 1104028364 - General Practice - 208D00000X

NPI Details
NPI 1104028364
Gender Male
Enumeration Date 06/01/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
6810 CANYON ST SE
SALEM OR, 97317-9024, US
Phone (503) 581-7379
Fax (503) 585-7816
Business Location
6810 CANYON ST SE
SALEM OR, 97317-9024, US
Phone (503) 581-7379
Fax (503) 585-7816
Toxanomy
Taxonomy Code 208D00000X
License State Oregon
License Number 6160
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According to our database, Dr. Ivan Dassenko MD NPI is 1104028364, taxonomy code is 208D00000X and license number is 6160, license state is located at Oregon. Ivan Dassenko MD physically located at 6810 Canyon St Se, Salem OR, 97317-9024. NPI Number Ivan Dassenko MD has the Individual type.

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1104028364 NPI number is provided on an as is basis without warranty of any kind. 1104028364 is maintained by the National Plan & Provider Enumeration System. The contents of Ivan Dassenko MD are for informational purposes only.