Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1235561143 |
---|---|
Provider Name | Abigail Tarr |
First Address | Vancouver, WA 98683-1460 |
Second Address | Vancouver, WA 98684-6053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2013 |
Last Update Date | 05/08/2013 |