Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA60980 | CA |
NPI | 1194182139 |
---|---|
Provider Name | Ann Margaret Mcclure |
First Address | Wilmington, CA 90744-1520 |
Second Address | Wilmington, CA 90744-1520 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2016 |
Last Update Date | 21/01/2016 |