Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1124783188 |
---|---|
Provider Name | Helen Boettner |
First Address | Sunnyvale, CA 94087-4394 |
Second Address | Sunnyvale, CA 94087-4394 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2021 |
Last Update Date | 04/11/2021 |