Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10183651 | OR |
NPI | 1477083145 |
---|---|
Provider Name | Mrs. Erin M Watkins |
First Address | Medford, OR 97504-4127 |
Second Address | Medford, OR 97504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2017 |
Last Update Date | 20/11/2019 |