Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | TX |
NPI | 1275087801 |
---|---|
Provider Name | Brianna L Gates |
First Address | Wahiawa, HI 96786-7539 |
Second Address | Wahiawa, HI 96786-7539 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2016 |
Last Update Date | 11/08/2016 |