Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6083 | OR |
NPI | 1003831579 |
---|---|
Provider Name | Michael E Lacey |
First Address | Eugene, OR 97401 |
Second Address | Eugene, OR 97401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |