Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 0002146 | CO |
NPI | 1073103081 |
---|---|
Provider Name | Diamond White |
First Address | Aurora, CO 80011-4020 |
Second Address | Auaroa, CO 80045 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2021 |
Last Update Date | 23/01/2021 |