Individual
DAN JOSEPH DETTMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
33894 SE EASTGATE CIR, CORVALLIS, OR 97333-2248
(541) 754-4901
Mailing address
261 BODEN ST, JUNCTION CITY, OR 97448-1525
(541) 913-5609
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
DT-DO-433361
OR
Other
Enumeration date
01/21/2009
Last updated
01/21/2009
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