Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 9419 | NC |
Y | 1223D0001X | Dental Public Health | 9419 | NC |
N | 1223G0001X | General Practice | 9419 | NC |
N | 213EG0000X | General Practice | 9419 | NC |
NPI | 1639413008 |
---|---|
Provider Name | Dr. Gladys Prieto |
First Address | Davidson, NC 28036-8094 |
Second Address | Davidson, NC 28036-8094 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2012 |
Last Update Date | 17/03/2015 |