Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 120364 | OR |
NPI | 1073923157 |
---|---|
Provider Name | Kaitlin West |
First Address | Gresham, OR 97080-8302 |
Second Address | Oregon City, OR 97045-1067 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2014 |
Last Update Date | 29/04/2014 |