Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH21534 | FL |
NPI | 1053718452 |
---|---|
Provider Name | Lauren Sweet |
First Address | Port St Lucie, FL 34983-3392 |
Second Address | Port St Lucie, FL 34986-1619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2014 |
Last Update Date | 01/12/2014 |