Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H2588 | OR |
NPI | 1073615316 |
---|---|
Provider Name | Mrs. Kristin A Bazor |
First Address | Beaverton, OR 97007 |
Second Address | Beaverton, OR 97005-3499 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
334 | KAISER PERMANENTE HEALTH (01) | OR |