Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H3708 | OR |
NPI | 1053597120 |
---|---|
Provider Name | Jean Mccloy |
First Address | Salem, OR 97306-2265 |
Second Address | Salem, OR 97305-1223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2008 |
Last Update Date | 18/01/2008 |