Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 4625 | MD |
NPI | 1053938282 |
---|---|
Provider Name | Laurie Beth Goodfriend |
First Address | University Park, MD 20782-2159 |
Second Address | College Park, MD 20740-3638 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2020 |
Last Update Date | 04/07/2020 |