Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H7335 | OR |
NPI | 1043751415 |
---|---|
Provider Name | Jesse Treanor |
First Address | Saint Helens, OR 97051-1283 |
Second Address | Beaverton, OR 97003-4443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2017 |
Last Update Date | 17/03/2017 |