Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10149646 | OR |
NPI | 1194148783 |
---|---|
Provider Name | Lindsay Elizabeth Corbett-Reiser |
First Address | Canby, OR 97013-3603 |
Second Address | Canby, OR 97013-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2014 |
Last Update Date | 03/02/2014 |