Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10190716 | OR |
NPI | 1104465525 |
---|---|
Provider Name | Mr. Andrew Kyle Burzynski |
First Address | Bend, OR 97701 |
Second Address | Bend, OR 97701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |