Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 120622 | OR |
NPI | 1104462340 |
---|---|
Provider Name | Amanda Noelle Jenkins |
First Address | Saint Helens, OR 97051-1311 |
Second Address | Beaverton, OR 97003-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2019 |
Last Update Date | 22/11/2019 |