Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10195126 | OR |
NPI | 1831752823 |
---|---|
Provider Name | Mr. Craig S Ward |
First Address | Eugene, OR 97440-3670 |
Second Address | Stayton, OR 97383-1703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2019 |
Last Update Date | 16/04/2019 |