Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10180873 | OR |
NPI | 1407367550 |
---|---|
Provider Name | Mrs. Codee L Hobart |
First Address | Grants Pass, OR 97527 |
Second Address | Grants Pass, OR 97527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 17/10/2017 |