Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6697 | OR |
NPI | 1013327956 |
---|---|
Provider Name | Anfisa Piatkoff |
First Address | Portland, OR 97230-6666 |
Second Address | Portland, OR 97230-6666 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 29/05/2014 |