Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 33373 | CA |
NPI | 1407420979 |
---|---|
Provider Name | Jessica Marie Mcguire |
First Address | Ben Lomond, CA 95005-9401 |
Second Address | Ben Lomond, CA 95005-9401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2021 |
Last Update Date | 18/05/2021 |