Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | D11428 | OR |
NPI | 1194332858 |
---|---|
Provider Name | Lindsey Theda |
First Address | Hood River, OR 97031-1956 |
Second Address | Hood River, OR 97031-1956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 14/09/2021 |