Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 78350 | TX |
NPI | 1225585797 |
---|---|
Provider Name | Crystal Williams |
First Address | Fort Hood, TX 76544-2021 |
Second Address | Fort Hood, TX 76544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |