Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 10125 | TN |
NPI | 1053981233 |
---|---|
Provider Name | Kayla Makenzie Dodson |
First Address | Carthage, TN 37030-3047 |
Second Address | Carthage, TN 37030-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 29/06/2021 |