Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D11280 | OR |
NPI | 1053812081 |
---|---|
Provider Name | Dr. Armin Afshar |
First Address | Keizer, OR 97303-4537 |
Second Address | Keizer, OR 97303-4537 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2018 |
Last Update Date | 02/09/2021 |