Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10154082 | OR |
NPI | 1821419243 |
---|---|
Provider Name | Stefan Lindenau |
First Address | Bend, OR 97701-3925 |
Second Address | Bend, OR 97701-3925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2014 |
Last Update Date | 07/02/2014 |