Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D8526 | OR |
NPI | 1073607115 |
---|---|
Provider Name | Mrs. Carolyn Ann Muckerheide |
First Address | Hillsboro, OR 97006-6952 |
Second Address | Hillsboro, OR 97006-6952 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |