Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1144985458 |
---|---|
Provider Name | Kimberly Ann Watson |
First Address | Portland, ME 04103-3442 |
Second Address | Portland, ME 04103-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2021 |
Last Update Date | 02/11/2021 |