Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | RDA87859 | CA |
NPI | 1033681523 |
---|---|
Provider Name | Crystal Nichole Davis |
First Address | Fresno, CA 93720-2698 |
Second Address | Fresno, CA 93720-2698 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2018 |
Last Update Date | 20/12/2018 |