Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1306297056 |
---|---|
Provider Name | Christian Rodriguez |
First Address | Jber, AK 99505 |
Second Address | Jber, AK 99505-8310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |