Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 023797 | NY |
NPI | 1063644292 |
---|---|
Provider Name | Jessica J Overton |
First Address | Pulaski, NY 13142-1400 |
Second Address | Pulaski, NY 13142-1400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2009 |
Last Update Date | 21/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00023797 | (05) | NY |