Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1073264941 |
---|---|
Provider Name | Jane K Mcintosh |
First Address | Jblm, WA 98433 |
Second Address | Jblm, WA 98433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2022 |
Last Update Date | 12/01/2022 |