Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | OR |
NPI | 1346701885 |
---|---|
Provider Name | Summer R Ridley |
First Address | Oregon City, OR 97045-1072 |
Second Address | Oregon City, OR 97045-1072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |