Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | OR |
NPI | 1174028369 |
---|---|
Provider Name | Rebecca Lynn Sherrett |
First Address | Portland, OR 97236-1386 |
Second Address | Portland, OR 97211-6613 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 28/03/2018 |