Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | 10150616 | OR |
NPI | 1851797823 |
---|---|
Provider Name | Rodrigo Castano |
First Address | Salem, OR 97301-5110 |
Second Address | Salem, OR 97301-4104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2014 |
Last Update Date | 18/10/2016 |