Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D8932 | OR |
NPI | 1003006941 |
---|---|
Provider Name | Dr. Christian Brent Pahls |
First Address | Coquille, OR 97423-1244 |
Second Address | Coquille, OR 97423-1244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 26/07/2007 |