Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30.24788 | OH |
NPI | 1003363631 |
---|---|
Provider Name | Giovanna Dainty |
First Address | Fort Sill, OK 73503 |
Second Address | Tacoma, WA 98431-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 25/11/2019 |