Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 015-0000618 | VT |
NPI | 1073730396 |
---|---|
Provider Name | Debra Bashford |
First Address | Brattleboro, VT 05301 |
Second Address | Brattleboro, VT 05301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
015-0000618 | HYGIENIST LICENSE (01) | VT |