Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 10028 | KY |
NPI | 1073012514 |
---|---|
Provider Name | Dr. Carli Loss |
First Address | Lexington, KY 40536-7001 |
Second Address | Lexington, KY 40536-7001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/02/2018 |
Last Update Date | 11/02/2018 |