Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D6793 | OR |
NPI | 1083837553 |
---|---|
Provider Name | Dr. Michael J. Ondo |
First Address | Bend, OR 97702-3201 |
Second Address | Bend, OR 97702-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 08/07/2007 |