Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 113482 | OR |
NPI | 1245580497 |
---|---|
Provider Name | Jennifer Christine Mcguire |
First Address | Gresham, OR 97080-9544 |
Second Address | Portland, OR 97202-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2012 |
Last Update Date | 14/09/2012 |