Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1306220868 |
---|---|
Provider Name | Marie Charlene Louisgene |
First Address | Milford, CT 06461-2903 |
Second Address | Milford, CT 06461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2015 |
Last Update Date | 25/08/2017 |