Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | D6427 | OR |
NPI | 1104825942 |
---|---|
Provider Name | Cynthia A. Layport |
First Address | Beaverton, OR 97007-6634 |
Second Address | Tigard, OR 97223-5502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2005 |
Last Update Date | 15/03/2012 |