Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10115004 | OR |
NPI | 1568501732 |
---|---|
Provider Name | Lilia Sentchouk |
First Address | Happy Valley, OR 97266-7374 |
Second Address | Happy Valley, OR 97266-7374 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |