Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1002870-16 | WI |
NPI | 1063863769 |
---|---|
Provider Name | Jennifer Hoerth |
First Address | Beloit, WI 53511-3550 |
Second Address | Beloit, WI 53511-3550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2016 |
Last Update Date | 07/07/2017 |