Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10193177 | OR |
N | 122400000X | Denturist | DT-TMP-10192123 | OR |
NPI | 1770078685 |
---|---|
Provider Name | Mrs. Lucille Levinia Becker |
First Address | Coburg, OR 97408-1301 |
Second Address | Sutherlin, OR 97479-9567 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2018 |
Last Update Date | 21/07/2020 |