Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10152790 | OR |
NPI | 1679912844 |
---|---|
Provider Name | Pieter Frederick Oosthuizen |
First Address | Jacksonville, OR 97530-9874 |
Second Address | Jacksonville, OR 97530-9873 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 20/06/2013 |