Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 6044 | AZ |
NPI | 1013168988 |
---|---|
Provider Name | Jean Haga |
First Address | Fountain Hills, AZ 85268-4173 |
Second Address | Fountain Hills, AZ 85268-4173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 08/10/2008 |