Medical school: MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE, GLENDALE
Graduated: 1998
NPI: 1801997226
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
940 ROYAL AVE
MEDFORD, OR 975046194
PROVIDENCE HEALTH AND SERVICES OREGON
965 ELLENDALE DR
MEDFORD, OR 975048215
5417326000
Source: CMS National Downloadable File, September 2026.