Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-740446 | OR |
NPI | 1609902881 |
---|---|
Provider Name | Mr. John Carl Busey |
First Address | Salem, OR 97301-4675 |
Second Address | Salem, OR 97301-4675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 17/01/2017 |