Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 023222-1 | NY |
NPI | 1023277878 |
---|---|
Provider Name | Lisa Rene Miller |
First Address | Buffalo, NY 14206-1649 |
Second Address | Buffalo, NY 14206-1649 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 06/06/2008 |