Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 31504 | CA |
NPI | 1073126884 |
---|---|
Provider Name | Lacey Danielle Armstrong |
First Address | Lakeside, CA 92040-4937 |
Second Address | Alpine, CA 91901-1668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2020 |
Last Update Date | 31/08/2020 |