Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6399 | OR |
N | 124Q00000X | Dental Hygienist | RDH 26847 | CA |
NPI | 1053754572 |
---|---|
Provider Name | Carol B. Lincer |
First Address | Newberg, OR 97132-7116 |
Second Address | Newberg, OR 97132-7116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 15/04/2013 |