Individual
MR. CODY MERRIL BYWATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICENSED DENTURIST
Contact information
Practice address
3900 DOUGLAS WAY, LAKE OSWEGO, OR 97035-3446
(503) 635-8060
(503) 305-8679
Mailing address
3900 DOUGLAS WAY, LAKE OSWEGO, OR 97035-3446
(503) 635-8060
(503) 305-8679
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DTDO10126042
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DTDO 10126042
DENTURIST HEALTH LICENSE STATE OF OREGON
OR
Enumeration date
10/31/2012
Last updated
10/31/2012
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