Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 0516733789 | OR |
NPI | 1730300823 |
---|---|
Provider Name | Mr. Dewayne Maurice Bremer |
First Address | Newport, OR 97365-3131 |
Second Address | Newport, OR 97365-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |