Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-636454 | OR |
NPI | 1073508529 |
---|---|
Provider Name | Mr. Grant Andrew Smith |
First Address | Eugene, OR 97404-0380 |
Second Address | Eugene, OR 97404-2047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 08/07/2007 |