Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 0040906 | OR |
NPI | 1043224546 |
---|---|
Provider Name | Amelia Juliano |
First Address | Salem, OR 97301-9253 |
Second Address | Salem, OR 97305-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 08/07/2007 |