Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 003178 | CT |
NPI | 1013319318 |
---|---|
Provider Name | Blanca Alban |
First Address | Springfield, MA 01109-1616 |
Second Address | Hartford, CT 06114-1215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 18/09/2014 |