Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 115243 | OR |
NPI | 1033264551 |
---|---|
Provider Name | Chandra Verhines |
First Address | Troutdale, OR 97060-2517 |
Second Address | Gresham, OR 97030-3852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 08/07/2007 |