Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | DENA000901 | DC |
NPI | 1023653318 |
---|---|
Provider Name | Jalisa Rita Parker |
First Address | Washington, DC 20020-3277 |
Second Address | Washington, DC 20020-7007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2019 |
Last Update Date | 11/11/2019 |