Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6017 | OR |
NPI | 1013205129 |
---|---|
Provider Name | Claire Martha Rose |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Beaverton, OR 97005-4402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 11/07/2011 |