Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H5057 | MN |
NPI | 1063798882 |
---|---|
Provider Name | Allison Dooley |
First Address | Cottage Grove, MN 55016-3886 |
Second Address | Cottage Grove, MN 55016-3886 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2011 |
Last Update Date | 25/10/2011 |