Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10133238 | OR |
NPI | 1144589102 |
---|---|
Provider Name | Mr. Ryan Charles Korando |
First Address | Florence, OR 97439-9586 |
Second Address | Florence, OR 97439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2012 |
Last Update Date | 11/05/2012 |