Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | CA |
NPI | 1225558422 |
---|---|
Provider Name | Candice James-Todd |
First Address | Long Beach, CA 90804-8866 |
Second Address | Long Beach, CA 90808-3938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2017 |
Last Update Date | 20/06/2017 |