Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | D 4107 | AZ |
NPI | 1003994336 |
---|---|
Provider Name | Dr. Yone Virginia Ponce |
First Address | Tucson, AZ 85716-3404 |
Second Address | Tucson, AZ 85716-3404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 14/03/2014 |