Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 14673 | TX |
NPI | 1003010414 |
---|---|
Provider Name | Janine Amber Witherspoon |
First Address | Mesquite, TX 75149-4868 |
Second Address | Plano, TX 75024-3316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2007 |
Last Update Date | 08/07/2007 |