Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DNF000411 | GA |
NPI | 1245749290 |
---|---|
Provider Name | Dr. Marlen Robles-Moreno |
First Address | Augusta, GA 30912-0004 |
Second Address | Augusta, GA 30912-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2017 |
Last Update Date | 25/10/2021 |