Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10186888 | OR |
NPI | 1821503293 |
---|---|
Provider Name | Mr. Calvin Daniel Smith |
First Address | Eugene, OR 97404 |
Second Address | Eugene, OR 97404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |