Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D7108 | OR |
NPI | 1144213851 |
---|---|
Provider Name | Dr. Brian Whitten |
First Address | Portland, OR 97201-5042 |
Second Address | Portland, OR 97201-5042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2005 |
Last Update Date | 16/07/2014 |