Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 15277 | TX |
NPI | 1023248127 |
---|---|
Provider Name | Ashleigh Reneau |
First Address | League City, TX 77573-2774 |
Second Address | League City, TX 77573-3369 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 23/07/2009 |