Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1154796746 |
---|---|
Provider Name | Kirsten Clute |
First Address | Beaverton, OR 97005-3460 |
Second Address | Beaverton, OR 97005-3460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2015 |
Last Update Date | 08/12/2015 |