Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402205509 | VA |
NPI | 1023610839 |
---|---|
Provider Name | Ashley Davidson |
First Address | Woodbridge, VA 22193-5955 |
Second Address | Lorton, VA 22079-4790 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2020 |
Last Update Date | 16/11/2020 |