Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 117461 | OR |
NPI | 1225674757 |
---|---|
Provider Name | Sarah Bachman |
First Address | Portland, OR 97202-4445 |
Second Address | Portland, OR 97202-4445 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2019 |
Last Update Date | 19/11/2019 |