Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5709 | OR |
NPI | 1023389079 |
---|---|
Provider Name | Diana Anatolievna Ipacs Szabo |
First Address | Salem, OR 97317-9238 |
Second Address | Salem, OR 97317-9238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2012 |
Last Update Date | 23/01/2012 |