Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 31036 | TX |
N | 1223G0001X | General Practice | 31036 | TX |
N | 213EG0000X | General Practice | 31036 | TX |
Y | 1223P0221X | Pediatric Dentist | 31036 | TX |
NPI | 1063893808 |
---|---|
Provider Name | Abrefi-Kete Asare |
First Address | Marietta, GA 30067-6405 |
Second Address | Laredo, TX 78046-6590 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2015 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F0217797 | DPS (01) | TX |