Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10120520 | OR |
NPI | 1891027306 |
---|---|
Provider Name | Mr. Greg Lee Robirts |
First Address | Redmond, OR 97756-2138 |
Second Address | Redmond, OR 97756-2138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2010 |
Last Update Date | 08/02/2010 |