Provider Demographics
NPI:1841650777
Name:PLOUSSARD, DANIELLE AMI (DDS, MD)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:AMI
Last Name:PLOUSSARD
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11786 SW BARNES RD STE 110
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5926
Mailing Address - Country:US
Mailing Address - Phone:503-444-6444
Mailing Address - Fax:503-444-4243
Practice Address - Street 1:11786 SW BARNES RD STE 110
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5926
Practice Address - Country:US
Practice Address - Phone:503-444-6444
Practice Address - Fax:503-444-4243
Is Sole Proprietor?:No
Enumeration Date:2016-03-04
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC2024-00524204E00000X
ORD10939204E00000X
WADR60650631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist