Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-087719 | OR |
NPI | 1235559253 |
---|---|
Provider Name | Albert Giddings II |
First Address | Brookings, OR 97415-0053 |
Second Address | Brookings, OR 97415-0053 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2014 |
Last Update Date | 17/04/2014 |