Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 11048 | TX |
NPI | 1033569777 |
---|---|
Provider Name | Everett Foster |
First Address | El Paso, TX 79920-5001 |
Second Address | El Paso, TX 79920-5001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2016 |
Last Update Date | 14/06/2016 |