Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 30.019149 | OH |
NPI | 1538579594 |
---|---|
Provider Name | Kristin Williams |
First Address | Cleveland, OH 44106-1712 |
Second Address | Cleveland, OH 44106-1712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2014 |
Last Update Date | 30/04/2014 |