Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | S6-188 | NV |
NPI | 1013485523 |
---|---|
Provider Name | Charlene Mo |
First Address | Las Vegas, NV 89102-4456 |
Second Address | Las Vegas, NV 89102-4456 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2018 |
Last Update Date | 10/11/2020 |