Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10185813 | OR |
NPI | 1831617968 |
---|---|
Provider Name | Eduardo Ramirez |
First Address | Roseburg, OR 97470-3260 |
Second Address | Roseburg, OR 97470-3260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 08/09/2017 |