Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D9468 | OR |
NPI | 1033424411 |
---|---|
Provider Name | Ashley Puleo Schaaf |
First Address | Beaverton, OR 97007-9713 |
Second Address | Beaverton, OR 97007-9713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2010 |
Last Update Date | 09/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
931321010 | GROUP PRACTICE (01) | OR |