Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 022716-1 | NY |
NPI | 1073164505 |
---|---|
Provider Name | Karen L Degroat |
First Address | Westtown, NY 10998-3801 |
Second Address | Warwick, NY 10990-1522 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2019 |
Last Update Date | 25/09/2019 |