Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122400000X | Denturist | DN 00000379 | WA |
Y | 122400000X | Denturist | DTDO838758 | OR |
NPI | 1891835112 |
---|---|
Provider Name | Mr. David R Chiovelli |
First Address | Clackamas, OR 97015 |
Second Address | Clackamas, OR 97015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DT-DO838758 | DENTURIST BOARD OF H (01) | OR |