Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant | 3227 | TX |
NPI | 1083931380 |
---|---|
Provider Name | Marquish Mckinnon |
First Address | Gonzales, TX 78629-3910 |
Second Address | Gonzales, TX 78629-3910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2010 |
Last Update Date | 26/04/2010 |