Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1316434277 |
---|---|
Provider Name | Kendra Jasmin Butcher |
First Address | Fort Leonard Wood, MO 65473-1618 |
Second Address | Fort Leonard Wood, MO 65473-9126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2018 |
Last Update Date | 17/04/2018 |