Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 113557 | OR |
NPI | 1003063835 |
---|---|
Provider Name | Mrs. Randeep Kaur |
First Address | Tigard, OR 97223-2609 |
Second Address | Beaverton, OR 97005-3460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2008 |
Last Update Date | 22/08/2008 |