Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-643631 | OR |
NPI | 1366574378 |
---|---|
Provider Name | Mr. Steven G Corbett |
First Address | Portland, OR 97223-1328 |
Second Address | Canby, OR 97013-3603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |