Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 10195475 | OR |
NPI | 1063074250 |
---|---|
Provider Name | Rajeev Rugi Siddappa |
First Address | Montclair, CA 91763-2424 |
Second Address | Seaside, OR 97138-6619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2019 |
Last Update Date | 08/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10195475 | OREGON DEPARTMENT OF HEALTH (01) | OR |