Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10186047 | OR |
NPI | 1013549575 |
---|---|
Provider Name | Christopher Scott Mayo JR. |
First Address | Brookings, OR 97415-0279 |
Second Address | Brookings, OR 97415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |