Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 1891 | SC |
NPI | 1033325980 |
---|---|
Provider Name | Juli Ann Brooks |
First Address | Taylors, SC 29687-4710 |
Second Address | Lexington, SC 29072-9316 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |