Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1582 | AR |
NPI | 1013928381 |
---|---|
Provider Name | Audra M Hamilton |
First Address | Augusta, AR 72006 |
Second Address | Augusta, AR 72006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 08/07/2007 |