Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D7471 | OR |
NPI | 1023193661 |
---|---|
Provider Name | Dr. Andrea J Laidlaw |
First Address | Hillsboro, OR 97123-4191 |
Second Address | Hillsboro, OR 97123-4191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 26/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
930719168 | TID (01) | OR |