Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH22777 | FL |
NPI | 1053837781 |
---|---|
Provider Name | Chantel Tanya Burnette |
First Address | Miami, FL 33142-2826 |
Second Address | Miami, FL 33142-2826 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2017 |
Last Update Date | 15/08/2017 |