Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | D010696 | AZ |
NPI | 1245765668 |
---|---|
Provider Name | Christine Antonio Lemon |
First Address | Las Vegas, NV 89147-6535 |
Second Address | Peoria, AZ 85381-5660 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2017 |
Last Update Date | 18/03/2021 |