Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 112756 | OR |
NPI | 1124645437 |
---|---|
Provider Name | Miss Ramona Ann Waits |
First Address | Gresham, OR 97030-7317 |
Second Address | Gresham, OR 97030-7317 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2020 |
Last Update Date | 02/07/2020 |