Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH069972 | PA |
N | 124Q00000X | Dental Hygienist | PHDH000381 | PA |
NPI | 1053553800 |
---|---|
Provider Name | Jessica L Boore |
First Address | York, PA 17401-1474 |
Second Address | York, PA 17401-1474 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2009 |
Last Update Date | 29/08/2017 |