Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10128751 | OR |
NPI | 1457581472 |
---|---|
Provider Name | Mr. Curtis F Tatlock |
First Address | Baker City, OR 97814-4121 |
Second Address | Baker City, OR 97814-4121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2009 |
Last Update Date | 24/07/2009 |