Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 118312-9920 | UT |
NPI | 1023239951 |
---|---|
Provider Name | Carey Underwood |
First Address | Sandy, UT 84093-3000 |
Second Address | Sandy, UT 84093-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 08/07/2007 |