Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTD962052 | OR |
NPI | 1225243363 |
---|---|
Provider Name | Edward Eplett |
First Address | Medford, OR 97504-6722 |
Second Address | Medford, OR 97504-6722 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |