Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6736 | OR |
NPI | 1063089225 |
---|---|
Provider Name | Miss Van Thuy Do |
First Address | Portland, OR 97217-6214 |
Second Address | Portland, OR 97232-1127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 07/06/2021 |