Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 18484 | TX |
NPI | 1023487253 |
---|---|
Provider Name | Daniel Badillo |
First Address | Alvin, TX 77511-2718 |
Second Address | Alvin, TX 77511-2718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2015 |
Last Update Date | 17/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18484 | CREDENTIALING (01) | TX |