Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4139 | MT |
NPI | 1033564919 |
---|---|
Provider Name | Amy Renea Silvan |
First Address | Great Falls, MT 59405-3034 |
Second Address | Great Falls, MT 59405-3034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |