Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10198679 | OR |
NPI | 1255997235 |
---|---|
Provider Name | Mr. Christopher Peter Mccarthy |
First Address | Portland, OR 97215-1446 |
Second Address | Portland, OR 97232-3094 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2019 |
Last Update Date | 15/09/2021 |