Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H1447 | OR |
NPI | 1053590927 |
---|---|
Provider Name | Mary Jane Davidson |
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 | 29/10/2007 |
Last Update Date | 29/10/2007 |