Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10130838 | OR |
NPI | 1881001337 |
---|---|
Provider Name | Eugenia Trusov |
First Address | Hillsboro, OR 97124-5611 |
Second Address | Hillsboro, OR 97124-5611 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2014 |
Last Update Date | 16/07/2014 |