Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 004054 | CT |
NPI | 1073716346 |
---|---|
Provider Name | Mary Calka |
First Address | Middletown, CT 06457-2718 |
Second Address | Norwalk, CT 06854-4901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |