Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH921 | NM |
NPI | 1013301373 |
---|---|
Provider Name | Debra Tapia |
First Address | Tijeras, NM 87059-8133 |
Second Address | Tijeras, NM 87059-8133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2015 |
Last Update Date | 25/03/2015 |