Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 114870 | OR |
NPI | 1245322882 |
---|---|
Provider Name | Loni Marie Mcnamara |
First Address | Vernonia, OR 97064 |
Second Address | Beaverton, OR 97005 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |