Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | G2-0002038 | DE |
NPI | 1023468410 |
---|---|
Provider Name | Deirdre Mccutcheon |
First Address | Dover, DE 19904-9450 |
Second Address | Dover, DE 19904-9450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 15/06/2016 |