Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1184881609 |
---|---|
Provider Name | Diane Renee Gatter |
First Address | Vancouver, WA 98665-9139 |
Second Address | Gresham, OR 97030-3852 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2008 |
Last Update Date | 21/05/2008 |