Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 08295 | IA |
N | 1223E0200X | Endodontist | 30-022494 | OH |
Y | 1223E0200X | Endodontist | D10911 | OR |
N | 1223G0001X | General Practice | 08295 | IA |
N | 213EG0000X | General Practice | 08295 | IA |
NPI | 1053312595 |
---|---|
Provider Name | Dr. Danielle Paige Wingrove |
First Address | Lake Oswego, OR 97035-1023 |
Second Address | Portland, OR 97201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 28/04/2021 |