Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH0008578 | FL |
NPI | 1003160706 |
---|---|
Provider Name | Karen A. Hodge |
First Address | Palm Harbor, FL 34683-4214 |
Second Address | Palm Harbor, FL 34683-4214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2012 |
Last Update Date | 01/11/2012 |