Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | PHDH000118 | PA |
NPI | 1013327725 |
---|---|
Provider Name | Beth Pantuso |
First Address | Coudersport, PA 16915-8161 |
Second Address | Coudersport, PA 16915-8161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2014 |
Last Update Date | 02/05/2014 |