Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 13003 | MA |
NPI | 1033425434 |
---|---|
Provider Name | Kirsten Deschamps |
First Address | S Yarmouth, MA 02664-1060 |
Second Address | S Yarmouth, MA 02664-1060 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2010 |
Last Update Date | 23/08/2010 |