Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 160 | OR |
NPI | 1043595903 |
---|---|
Provider Name | Mr. Edward Espinoza JR. |
First Address | Portland, OR 97213-7016 |
Second Address | Portland, OR 97213-7016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2011 |
Last Update Date | 11/10/2011 |