Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 011470-1 | NY |
NPI | 1003253428 |
---|---|
Provider Name | Deborah A Fent |
First Address | Akwesasne, NY 13655-3109 |
Second Address | Akwesasne, NY 13655-3109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2013 |
Last Update Date | 24/05/2013 |