Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | S3-74 | NV |
NPI | 1053487637 |
---|---|
Provider Name | Meagan Struby |
First Address | Sparks, NV 89431-3879 |
Second Address | Sparks, NV 89431-3879 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 08/07/2007 |