NPI 1104028364

Ivan Dassenko, MD

Practitioner General Practice Physician Salem, OR

Practice location

Address: 6810 Canyon St SE, Salem, OR 97317-9024
Phone: (503) 581-7379
Fax: (503) 585-7816

Registered specialties

General Practice Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 208D00000X Licence 6160 (OR)

Other General Practice providers in Oregon →

Registry record

NPI: 1104028364
Entity type: Individual
Sex (as registered): Male
NPI issued: 1 Jun 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.