Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 024616 | NY |
NPI | 1053970665 |
---|---|
Provider Name | Angela Lai |
First Address | Brooklyn, NY 11220-2712 |
Second Address | Brooklyn, NY 11220-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2019 |
Last Update Date | 07/06/2019 |