Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS038361 | PA |
NPI | 1760796767 |
---|---|
Provider Name | Dr. Marissa Marie Kuhnen |
First Address | Flagstaff, AZ 86004-7843 |
Second Address | Winslow, AZ 86047-2169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2010 |
Last Update Date | 02/08/2010 |