Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H2795 | OR |
NPI | 1013202720 |
---|---|
Provider Name | Jodi A Budd |
First Address | Gresham, OR 97030-0132 |
Second Address | Oakridge, OR 97463-9572 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2011 |
Last Update Date | 01/10/2021 |