Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12303 | NC |
N | 1223P0221X | Pediatric Dentist | 12303 | NC |
NPI | 1023690336 |
---|---|
Provider Name | Caitlin Null |
First Address | Greensboro, NC 27410-8383 |
Second Address | Greensboro, NC 27409-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2021 |
Last Update Date | 22/06/2021 |