Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist |
NPI | 1043660590 |
---|---|
Provider Name | Julliam Dones |
First Address | Fort Eustis, VA 23604-1526 |
Second Address | Fort Lee, VA 23801-1717 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2016 |
Last Update Date | 15/06/2016 |