Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3101 | OR |
NPI | 1023050044 |
---|---|
Provider Name | Carol A. Poe |
First Address | Roseburg, OR 97470-8478 |
Second Address | Roseburg, OR 97470-8478 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 23/06/2011 |