Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1215561592 |
---|---|
Provider Name | Kelsey Anne Moore |
First Address | San Antonio, TX 78215-1528 |
Second Address | San Antonio, TX 78215-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2020 |
Last Update Date | 26/02/2020 |