Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 008102 | CT |
NPI | 1003246042 |
---|---|
Provider Name | Deanna Dennis |
First Address | Wellesley, MA 02482-3744 |
Second Address | Middletown, CT 06457-3397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 23/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008049103 | (05) | CT |