Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 0402004270 | VA |
NPI | 1073965588 |
---|---|
Provider Name | Laura Pierce |
First Address | Fort George G. Meade, MD 20755 |
Second Address | Fort George G. Meade, MD 20755 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2016 |
Last Update Date | 08/07/2016 |