Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 020.011177 | IL |
NPI | 1073934956 |
---|---|
Provider Name | Anita Birton |
First Address | Chicago, IL 60617-1764 |
Second Address | Chicago, IL 60608-5107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2013 |
Last Update Date | 25/12/2013 |