Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5122 | OR |
NPI | 1013084342 |
---|---|
Provider Name | Simona Hutanu |
First Address | Beaverton, OR 97007-9200 |
Second Address | Beaverton, OR 97006-4443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 08/07/2007 |