Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D10398 | OR |
N | 204E00000X | Oral & Maxillofacial Surgeon | S-476 | LA |
NPI | 1245440676 |
---|---|
Provider Name | Nathan D Lenox |
First Address | Bend, OR 97702 |
Second Address | Bend, OR 97702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07904 | (05) | LA |