Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-663650 | OR |
NPI | 1073589172 |
---|---|
Provider Name | Mr. Chris Robert Chapman |
First Address | Hood River, OR 97031-1538 |
Second Address | Hood River, OR 97031-1538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DT-DO-663650 | STATE LICENSE NUMBER (01) | OR |