Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 2901016364 | MI |
Y | 1223D0001X | Dental Public Health | D6888 | AZ |
NPI | 1144366527 |
---|---|
Provider Name | Dr. Mona Chami |
First Address | Phoenix, AZ 85023-7900 |
Second Address | Parker, AZ 85344-7718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
618481 | (05) | AZ |