Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-460587 | OR |
NPI | 1487859344 |
---|---|
Provider Name | Mr. Otto F Meza |
First Address | Lake Oswego, OR 97035-8228 |
Second Address | Woodburn, OR 97071-3656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127352 | DIV. MED. ASST. PROGRAMS (01) | OR |
DT-DO-460587 | OREGON HEALTH LICENSING # (01) | OR |