Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | H6618 | OR |
NPI | 1083026884 |
---|---|
Provider Name | Kyle Isaacs |
First Address | Monroe, OR 97456-9745 |
Second Address | Monroe, OR 97456-9745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 28/05/2014 |