Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH00009418 | WA |
NPI | 1033316674 |
---|---|
Provider Name | Kimberly A Smith |
First Address | Colville, WA 99114-2310 |
Second Address | Colville, WA 99114-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5901624 | (05) | WA |