Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN015262 | GA |
NPI | 1003358656 |
---|---|
Provider Name | Daniela Martinez Florez |
First Address | Clarkston, GA 30021-1838 |
Second Address | Clarkston, GA 30021-1838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2016 |
Last Update Date | 14/11/2016 |