Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 113490 | OR |
NPI | 1356878771 |
---|---|
Provider Name | Stacey Irene Inloes |
First Address | Oregon City, OR 97045-8929 |
Second Address | Clackamas, OR 97015-9782 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2017 |
Last Update Date | 16/05/2017 |