Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 12018979 | OR |
NPI | 1114003035 |
---|---|
Provider Name | Dr. Sandra Carmeci |
First Address | Medford, OR 97504 |
Second Address | Medford, OR 97504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 17/09/2008 |