Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH27627 | FL |
NPI | 1053917054 |
---|---|
Provider Name | Carlos Humberto Sierra |
First Address | Inverness, FL 34450-4150 |
Second Address | Inverness, FL 34453-3216 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2020 |
Last Update Date | 07/12/2020 |