Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH15515 | FL |
NPI | 1003368184 |
---|---|
Provider Name | Lauren Buxman |
First Address | Daytona Beach, FL 32117-5114 |
Second Address | Daytona Beach, FL 32117-5114 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |