Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1003315094 |
---|---|
Provider Name | Jodell Denno |
First Address | Flint, MI 48532-3614 |
Second Address | Flint, MI 48532-3614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2018 |
Last Update Date | 17/03/2018 |