Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 93-0798039 | OR |
NPI | 1144810045 |
---|---|
Provider Name | Gail A Young |
First Address | Keizer, OR 97303-1500 |
Second Address | Keizer, OR 97303-1500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2021 |
Last Update Date | 25/01/2021 |