Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-516828 | OR |
NPI | 1861532897 |
---|---|
Provider Name | Christopher Van Doran |
First Address | Albany, OR 97322-5248 |
Second Address | Albany, OR 97322-5248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |