Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 157306 | AK |
NPI | 1194326777 |
---|---|
Provider Name | Holly Suzahn Knight |
First Address | Ketchikan, AK 99901-9766 |
Second Address | San Antonio, TX 78215-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2020 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
157306 | RDA (01) | AK |
157306 | RDA- CONTRACTOR (01) | AK |