Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | DH043449 | GA |
NPI | 1003578816 |
---|---|
Provider Name | Megan Elizabeth Kafitz |
First Address | Kings Bay, GA 31547-2531 |
Second Address | Kings Bay, GA 31547-2531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2021 |
Last Update Date | 08/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DH043449 | DENTAL HYGIENE LICENCE (01) | GA |