Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10125322 | OR |
NPI | 1366686099 |
---|---|
Provider Name | Mrs. Mary Catherine Ledesma |
First Address | Salem, OR 97302-4762 |
Second Address | Salem, OR 97302-4762 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 24/04/2009 |