Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 2902016122 | MI |
NPI | 1023481454 |
---|---|
Provider Name | Maria Guzman |
First Address | Detroit, MI 48216-2200 |
Second Address | Detroit, MI 48210-3039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2015 |
Last Update Date | 06/11/2015 |