Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 3165 | ME |
NPI | 1073967899 |
---|---|
Provider Name | Darcy Burgess |
First Address | Dover Foxcroft, ME 04426-1022 |
Second Address | Dover Foxcroft, ME 04426-1022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2016 |
Last Update Date | 18/04/2016 |