Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902002825 | MI |
NPI | 1023045929 |
---|---|
Provider Name | Christine Anne Sandera |
First Address | Bangor, MI 49013 |
Second Address | Holland, MI 49424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 08/07/2007 |