Provider Demographics
NPI:1740408525
Name:VOLANSKY, MARY ELLEN (RDH MS LAP)
Entity Type:Individual
Prefix:MS
First Name:MARY ELLEN
Middle Name:
Last Name:VOLANSKY
Suffix:
Gender:F
Credentials:RDH MS LAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 WEST 26TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2533
Mailing Address - Country:US
Mailing Address - Phone:541-342-8676
Mailing Address - Fax:541-342-8676
Practice Address - Street 1:107 SE SWAN AVENUE
Practice Address - Street 2:CTSI DENTAL CLINIC
Practice Address - City:SILETZ
Practice Address - State:OR
Practice Address - Zip Code:97380
Practice Address - Country:US
Practice Address - Phone:541-444-9640
Practice Address - Fax:541-444-9695
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH3649124Q00000X
NY0124001124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist