Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3290-020DH | MS |
NPI | 1073542601 |
---|---|
Provider Name | Annie Mccline |
First Address | Jackson, MS 39213-4454 |
Second Address | Jackson, MS 39213-4454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 08/07/2007 |