Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1013552504 |
---|---|
Provider Name | Anquetta Monique Cooper |
First Address | Savannah, GA 31401-2917 |
Second Address | Savannah, GA 31401-2917 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2019 |
Last Update Date | 08/11/2019 |