Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | EFDA 01071 | OH |
NPI | 1184013989 |
---|---|
Provider Name | Charlette Boykin |
First Address | Dayton, OH 45414-3846 |
Second Address | Centerville, OH 45459-4243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2015 |
Last Update Date | 16/01/2015 |