Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 002024375 | CO |
NPI | 1073974127 |
---|---|
Provider Name | Kylie Rae Lunka |
First Address | Denver, CO 80237-3490 |
Second Address | Denver, CO 80237-3490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 17/03/2016 |