Provider Demographics
NPI:1376708958
Name:JUSON, NATALYA A (DMD)
Entity Type:Individual
Prefix:MRS
First Name:NATALYA
Middle Name:A
Last Name:JUSON
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 1:180 ATWATER ST. NW
Mailing Address - Street 2:WEST SALEM CLINIC DENTAL
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304
Mailing Address - Country:US
Mailing Address - Phone:503-315-0712
Mailing Address - Fax:503-315-0721
Practice Address - Street 1:180 ATWATER ST. NW
Practice Address - Street 2:WEST SALEM CLINIC DENTAL
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304
Practice Address - Country:US
Practice Address - Phone:503-315-0712
Practice Address - Fax:503-315-0721
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9140122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist