Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1134781230 |
---|---|
Provider Name | Michelle Ashley Martin |
First Address | Colorado Springs, CO 80920-4952 |
Second Address | Colorado Springs, CO 80920-1057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2019 |
Last Update Date | 28/06/2019 |