Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 16589 | NY |
NPI | 1073021812 |
---|---|
Provider Name | Kathleen M Drag |
First Address | Poughkeepsie, NY 12603-3410 |
Second Address | Poughkeepsie, NY 12601-4026 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2018 |
Last Update Date | 15/01/2018 |