Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | DF-002-111-L-T | PA |
NPI | 1184666224 |
---|---|
Provider Name | Donna J Passino |
First Address | Scranton, PA 18505-2003 |
Second Address | Scranton, PA 18509-3023 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |