Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 60667 | CA |
NPI | 1184142291 |
---|---|
Provider Name | Beth Anne Frahn |
First Address | Hemet, CA 92544-5189 |
Second Address | Los Angeles, CA 90025-1188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2017 |
Last Update Date | 08/09/2017 |