Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTDO694389 | OR |
NPI | 1801017033 |
---|---|
Provider Name | Beverly Vernwald |
First Address | Portland, OR 97203-1368 |
Second Address | Milwaukie, OR 97267-1300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |