Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D7380 | OR |
NPI | 1184703324 |
---|---|
Provider Name | Dr. Athena Marie Bettger |
First Address | Portland, OR 97221-3377 |
Second Address | Gresham, OR 97030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 08/07/2007 |