Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 4527 | NV |
N | 122400000X | Denturist |
NPI | 1427585744 |
---|---|
Provider Name | Heidi Dickerson |
First Address | Las Vegas, NV 89134-6366 |
Second Address | Las Vegas, NV 89134-0527 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2017 |
Last Update Date | 17/05/2017 |