Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DTDO539081 | OR |
NPI | 1235359852 |
---|---|
Provider Name | Mr. Kenneth Neil Holden |
First Address | Eugene, OR 97401 |
Second Address | Corvallis, OR 97330 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 08/07/2007 |