Provider Demographics
NPI:1023389079
Name:IPACS SZABO, DIANA ANATOLIEVNA (RDH, BS, LAP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:ANATOLIEVNA
Last Name:IPACS SZABO
Suffix:
Gender:F
Credentials:RDH, BS, LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 MACLEAY RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97317-9238
Mailing Address - Country:US
Mailing Address - Phone:503-956-8811
Mailing Address - Fax:
Practice Address - Street 1:5770 MACLEAY RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9238
Practice Address - Country:US
Practice Address - Phone:503-956-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5709124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist