Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 11329 | TX |
NPI | 1053442376 |
---|---|
Provider Name | Mica Mcdonald |
First Address | Keller, TX 76248-6951 |
Second Address | Hurst, TX 76054-3047 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 12/01/2009 |