Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 126800000X | Dental Assistant | ||
Y | 126800000X | Dental Assistant | DE |
NPI | 1134650765 |
---|---|
Provider Name | Carol Manuel |
First Address | Wilmington, DE 19805-1325 |
Second Address | Wilmington, DE 19805-1335 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2017 |
Last Update Date | 24/03/2017 |