Provider Demographics
NPI:1669803144
Name:DAFINESCU, MIA
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:DAFINESCU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30390 SW ROGUE LN
Mailing Address - Street 2:#3006
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6653
Mailing Address - Country:US
Mailing Address - Phone:503-913-6330
Mailing Address - Fax:
Practice Address - Street 1:30390 SW ROGUE LN
Practice Address - Street 2:#3006
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-6653
Practice Address - Country:US
Practice Address - Phone:503-913-6330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant