Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTDO317601 | OR |
NPI | 1356406342 |
---|---|
Provider Name | Melanie J Block |
First Address | Portland, OR 97232-3094 |
Second Address | Portland, OR 97232-3094 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 06/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269892 | (05) | OR |