Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1053079699 |
---|---|
Provider Name | Angela Weeks |
First Address | Harker Heights, TX 76548-2342 |
Second Address | Fort Hood, TX 76544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2021 |
Last Update Date | 01/12/2021 |