Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | DT-DO-10163614 | OR |
NPI | 1154723831 |
---|---|
Provider Name | William Castle |
First Address | Eugene, OR 97402-3207 |
Second Address | Eugene, OR 97402-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2014 |
Last Update Date | 24/09/2014 |