Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 12013442A | IN |
NPI | 1487262531 |
---|---|
Provider Name | Dr. Chloe Katherine Mounayar |
First Address | La Porte, IN 46350-5339 |
Second Address | La Porte, IN 46350-5339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2020 |
Last Update Date | 24/01/2021 |