Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DDS-09925 | IA |
NPI | 1003487711 |
---|---|
Provider Name | Kassie Rae Sopher |
First Address | Des Moines, IA 50309-4314 |
Second Address | Des Moines, IA 50316-2461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2021 |
Last Update Date | 03/07/2021 |