Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 00001918 | WA |
NPI | 1033441845 |
---|---|
Provider Name | Jo Moore |
First Address | Bellevue, WA 98008-5125 |
Second Address | Bellevue, WA 98008-5125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2010 |
Last Update Date | 03/02/2010 |