Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 002327 | MO |
NPI | 1205161726 |
---|---|
Provider Name | Kimberly Ann George |
First Address | Anderson, MO 64831-1136 |
Second Address | Anderson, MO 64831 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2009 |
Last Update Date | 16/10/2009 |