Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH008596 | GA |
NPI | 1013343144 |
---|---|
Provider Name | Kendra Latrice Watkins |
First Address | Lithonia, GA 30058-7002 |
Second Address | Washington, DC 20422-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2013 |
Last Update Date | 20/09/2013 |