Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT00524581 | OR |
NPI | 1629308648 |
---|---|
Provider Name | Theodore Keith Dhein |
First Address | Portland, OR 97206-5148 |
Second Address | Portland, OR 97206-5148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2010 |
Last Update Date | 14/01/2010 |