Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10182265 | OR |
NPI | 1013433853 |
---|---|
Provider Name | Andres Adalbeto Aguilar JR. |
First Address | Salem, OR 97305-1435 |
Second Address | Salem, OR 97305-1435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |