Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1023365186 |
---|---|
Provider Name | Debra Ann Dayton |
First Address | Fairbanks, AK 99701-4803 |
Second Address | Fairbanks, AK 99701-4803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2012 |
Last Update Date | 08/08/2012 |