Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DN00000216 | WA |
NPI | 1548279854 |
---|---|
Provider Name | Mr. Eugene Reinhardt Miller JR. |
First Address | Portland, OR 97217-8080 |
Second Address | Vancouver, WA 98686-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 08/07/2007 |