Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH60871449 | WA |
NPI | 1073079984 |
---|---|
Provider Name | Lyndsey Smith |
First Address | Longview, WA 98632-2509 |
Second Address | Longview, WA 98632-2509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2019 |
Last Update Date | 15/02/2019 |