Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 8792 | NC |
NPI | 1013589506 |
---|---|
Provider Name | Jessica Venegas |
First Address | Camp Lejuene, NC 28542-0130 |
Second Address | Camp Lejuene, NC 28542-0130 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2021 |
Last Update Date | 14/07/2021 |