Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3026 | OK |
NPI | 1003070962 |
---|---|
Provider Name | Chase Te Idleman |
First Address | Oklahoma City, OK 73127-6339 |
Second Address | Oklahoma City, OK 73127-6339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2008 |
Last Update Date | 10/07/2008 |