Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A0628 | OR |
NPI | 1245584267 |
---|---|
Provider Name | Mrs. Roselynn D Dixon |
First Address | Troutdale, OR 97060-1533 |
Second Address | Portland, OR 97232-1127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2012 |
Last Update Date | 29/10/2012 |