Provider Demographics
NPI:1952529661
Name:LACRAMPE, ETIENNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ETIENNE
Middle Name:
Last Name:LACRAMPE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11982 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2143
Mailing Address - Country:US
Mailing Address - Phone:503-257-8787
Mailing Address - Fax:
Practice Address - Street 1:1844 SAN MIGUEL DR STE 209
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4913
Practice Address - Country:US
Practice Address - Phone:925-937-6350
Practice Address - Fax:925-937-6352
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA587711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics