Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1063726453 |
---|---|
Provider Name | Denise Machinea |
First Address | Dunwoody, GA 30338-4106 |
Second Address | Dunwoody, GA 30338-4106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2010 |
Last Update Date | 28/07/2010 |