Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122400000X | Denturist | S-1024732 | NY |
NPI | 1437487576 |
---|---|
Provider Name | Melissa Elaine Reese |
First Address | South Fallsburg, NY 12779 |
Second Address | South Fallsburg, NY 12779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2009 |
Last Update Date | 01/12/2009 |