Provider Demographics
NPI:1508143041
Name:SEPPALA, REBECCA ELIZABETH (DMD)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ELIZABETH
Last Name:SEPPALA
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 1:2375 SW CEDAR HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-4513
Mailing Address - Country:US
Mailing Address - Phone:503-941-5869
Mailing Address - Fax:503-941-5982
Practice Address - Street 1:2375 SW CEDAR HILLS BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-4513
Practice Address - Country:US
Practice Address - Phone:503-941-5869
Practice Address - Fax:503-941-5982
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR9173122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist