Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 36847 | TX |
NPI | 1043812332 |
---|---|
Provider Name | Dr. Chanica Veranunt |
First Address | Rosharon, TX 77583 |
Second Address | Rosharon, TX 77583 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2020 |
Last Update Date | 11/12/2020 |