Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 028856-1 | NY |
NPI | 1073060877 |
---|---|
Provider Name | Kristin Renee Forte |
First Address | Marion, NY 14505-9302 |
Second Address | Marion, NY 14505-9302 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2016 |
Last Update Date | 08/09/2016 |