Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H1590 | OR |
NPI | 1043590078 |
---|---|
Provider Name | Ann Peront |
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 | 22/08/2011 |
Last Update Date | 22/08/2011 |