Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 34950 | TX |
NPI | 1053974253 |
---|---|
Provider Name | Megan Laughinghouse Favor |
First Address | Hondo, TX 78861-2845 |
Second Address | Hondo, TX 78861-2531 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2019 |
Last Update Date | 16/10/2019 |