Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A0626 | OR |
NPI | 1366508061 |
---|---|
Provider Name | Mrs. Juliet Marie Spaulding |
First Address | Sandy, OR 97055-7236 |
Second Address | Portland, OR 97230-6708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 08/07/2007 |