Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 000905162 | CO |
NPI | 1013395664 |
---|---|
Provider Name | Joni Jill Jones |
First Address | Pagosa Springs, CO 81147-2336 |
Second Address | Pagosa Springs, CO 81147-2336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2015 |
Last Update Date | 15/05/2015 |