Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10126244 | OR |
NPI | 1942556105 |
---|---|
Provider Name | Mrs. Molly A Eekhoff |
First Address | La Grande, OR 97850-2253 |
Second Address | La Grande, OR 97850-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2012 |
Last Update Date | 25/07/2012 |