Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D5558 | OR |
NPI | 1003813312 |
---|---|
Provider Name | Dr. Ulrich Guenter Schockelt |
First Address | Forest Grove, OR 97116-2276 |
Second Address | Forest Grove, OR 97116-2276 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 08/07/2007 |