Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 682 | MT |
NPI | 1003235409 |
---|---|
Provider Name | Dawn Anderson |
First Address | Kalispell, MT 59903-2378 |
Second Address | Kalispell, MT 59901-8054 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2014 |
Last Update Date | 14/04/2014 |