Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | A2312 | OR |
NPI | 1225141898 |
---|---|
Provider Name | Ms. Lori L Virell |
First Address | Portland, OR 97233-3960 |
Second Address | Portland, OR 97220-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2006 |
Last Update Date | 08/07/2007 |