Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H2845 | OR |
NPI | 1073950465 |
---|---|
Provider Name | Ms. Denise Ann Enos |
First Address | Eugene, OR 97401-7833 |
Second Address | Eugene, OR 97401-7833 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2013 |
Last Update Date | 27/05/2013 |