Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-237679 | OR |
NPI | 1518074673 |
---|---|
Provider Name | David Russell Dahl |
First Address | Medford, OR 97501-5727 |
Second Address | Medford, OR 97501-5727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |