Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 3323 | AR |
NPI | 1134134703 |
---|---|
Provider Name | Dr. Marny L Lemons-Prince |
First Address | Little Rock, AR 72205-1558 |
Second Address | Little Rock, AR 72205-1558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 01/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3323 | DENTAL LICENSE (01) | AR |