Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10197097 | OR |
NPI | 1639713019 |
---|---|
Provider Name | Mr. Kazuyuki Matsuoka |
First Address | Tualatin, OR 97062-7398 |
Second Address | Newport, OR 97365-3131 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |