Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 7104 | OK |
NPI | 1679052856 |
---|---|
Provider Name | Hayley Beth Shenberger |
First Address | Muskogee, OK 74403-7218 |
Second Address | Muskogee, OK 74403-6253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2018 |
Last Update Date | 09/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7104 | OKLAHOMA DENTAL LICENSE NUMBER (01) | OK |