Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H009866 | AZ |
NPI | 1003486135 |
---|---|
Provider Name | Chloe Strike |
First Address | Flagstaff, AZ 86001-7141 |
Second Address | Flagstaff, AZ 86004-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2021 |
Last Update Date | 30/06/2021 |