Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 022823-1 | NY |
NPI | 1003247495 |
---|---|
Provider Name | Kelly Vogt |
First Address | Dansville, NY 14437-9048 |
Second Address | Dansville, NY 14437-9048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2013 |
Last Update Date | 10/12/2013 |