Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002023914 | CO |
NPI | 1043602782 |
---|---|
Provider Name | Aubrey C Lesh |
First Address | Colorado Springs, CO 80923-3580 |
Second Address | Colorado Springs, CO 80923-3580 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2015 |
Last Update Date | 03/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002023914 | (05) | CO |