Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D7792 | OR |
NPI | 1003801069 |
---|---|
Provider Name | Dr. Inna V Shimanovsky |
First Address | Tigard, OR 97223-1779 |
Second Address | Oak Grove, OR 97267-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2005 |
Last Update Date | 08/07/2007 |