Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4703 | NV |
N | 122300000X | Dentist | 52098 | CA |
NPI | 1003999889 |
---|---|
Provider Name | Elizabeth Park |
First Address | Gardnerville, NY 89460 |
Second Address | Carson City, NV 89703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 08/07/2007 |