Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 81020 | CA |
NPI | 1295169985 |
---|---|
Provider Name | Haley Anne Gebhart |
First Address | Tehachapi, CA 93561-8834 |
Second Address | Lancaster, CA 93534-3333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2013 |
Last Update Date | 29/08/2013 |