Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1073026621 |
---|---|
Provider Name | Natosha L Bannister |
First Address | Portland, OR 97232-1127 |
Second Address | Portland, OR 97232-1127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2017 |
Last Update Date | 06/11/2017 |