Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1346647518 |
---|---|
Provider Name | Gina Pyron |
First Address | Scottsdale, AZ 85251-5648 |
Second Address | Scottsdale, AZ 85251-5648 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2014 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
45-5437631 | SOUTHWEST JAW SURGEONS (01) | AZ |