Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 22DP00517600 | NJ |
NPI | 1154612182 |
---|---|
Provider Name | Bonnie Lee Mccleary |
First Address | Cinnaminson, NJ 08077-2933 |
Second Address | Voorhees, NJ 08043-2514 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |