Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1336438365 |
---|---|
Provider Name | Jessica Carragher |
First Address | Tulsa, OK 74135-4035 |
Second Address | Sapulpa, OK 74066-4505 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 30/03/2011 |