Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6305 | OR |
NPI | 1053669838 |
---|---|
Provider Name | Mrs. Katarzyna Teegarden |
First Address | Vancouver, WA 98682-7306 |
Second Address | Portland, OR 97217-5523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2012 |
Last Update Date | 27/08/2012 |