Provider Demographics
NPI:1073658407
Name:SWITZER, MAILYN ELIZABETH (DMD)
Entity Type:Individual
Prefix:
First Name:MAILYN
Middle Name:ELIZABETH
Last Name:SWITZER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4503
Mailing Address - Country:US
Mailing Address - Phone:503-472-0820
Mailing Address - Fax:503-435-0551
Practice Address - Street 1:344 NE GALLOWAY ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4513
Practice Address - Country:US
Practice Address - Phone:503-472-7592
Practice Address - Fax:503-435-0551
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR93-0960852OtherTAX ID #