Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10137920 | OR |
NPI | 1194018564 |
---|---|
Provider Name | Teresa J Waite |
First Address | Eugene, OR 97440-3670 |
Second Address | Bend, OR 97701-6068 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2011 |
Last Update Date | 03/09/2019 |